
1 



POPULAR MEDICINE; 

OR, 

FAMILY ADVISER; 

CONSISTING OF 

OUTLINES 

en 

ANATOMY, PHYSIOLOGT , \M) HYGIENE, 

| M « 11 HINTS Os 

PRACTICE OF PHYSIC, BURGERYi 

DH WOMEN AND CHILDREN, 

■ 
I'm SH 1 w- CANN< :» : 

nmo a compam >n \m> iii.im i'kim-ipaui or mamfac- 

I VMM !<•■- | VMIUBS, 

MAM i HHLlV Ml*sl "^AKIfcs « i: ikwiiiikm Al 

i it 11 T< 11 MMENO1N0 

mho CM mi DI< 






BY 

i: i m. I). 

•k — 

Rttl | llur|>iUl, A.r.— 

Awiitc.l l»y ievcra 



PHILAINBLPHIAi 
i.\. !.i LANCHAKD. 

1838. 



c 



Entered according to the Act of Congress m the year 1838, by Ca*h 

I lcrk's Office of the Eastern District ofcPennayhrania. 



3: 



/ 



TO 

JOHN (i I M M E R B, Esq., 

PRINCIPAL OP FRIEND»' HIGH SCHOOL AT UAVERPORD, 

UNDER WHOSE AUSPICES, IN I HABITS OP RE8EAK 1FLEC- 

I, is. i I' mid tl 1 MC DEBT OF 

WERE SYSTEMATIZED, ESTABLISH D. AND || | vILARLE, 

THI8 LITTLI WO* 
ii 
RR8PECTFU LL1 DBDII LTED 

HV HI* HBO AND FORMER l'l | 

i 

i A I I UOR. 



PREFACE. 



medical pmfiiMMWi has op 
the publication of ine, and 

Le public, t<> attribute their 

The pr of the present I , bowei 

lull j ma] !>iv- 

.11 knnu in«j- th( nine. 

mcmej . and oouih 

onoeafl 
promote the umanitj a, on 

band, thai it is ii immun 

praotii i of di 

without em] roducinj 

calculab behalf of 

thai profi ssion the I ave been 

Ins life, nil eh r 01 meanly 

mercenary . opoo 

roletri men u|i to undergo the 

mum of labom for the minimum 

Bu1 it appears to (be author, that the principal i rill 

which h ilted, and ait \\\n-\\ 

I attempts at popular mcdiral in-' :. arc at- 

tribvtable rather to the (Banner in which the robjecl 

\\ iih<»ui wishing torn the meril i 

verai public, be beherea that 

all his pr< tiave passed tOOsHghtlj over inan\ 

matters wki rendered quite intelligible to 



VI l»Ri 

persons unacquainted with the science of medicim 

while they have attempted to lay down d: 

the treatment of many states or conditions 

which can only be distinguished wit 

managed with success, by thos 

the moral light to employ the i ■ . but i 

dangerous weapons by 

learning, aided by lone 

experience, tn ventun _ . the 

endeavour h;< 

tioned; — with what 

mine. 

It Form* 
an u 1 1 

when such advice can 
time, he is not a 
eonsii 

consideration i so- 

il. — if hu- 

manity would ; 

wealth and 

id will i 
and their 
which / 

lYr 
to elude 
Ions, i 
thus pre 

The gent] 
whose situal 
thren in England, will 
effort 

which is at once anno 
appears censurable in I 
serious evils gnra bag 
regularly educated portion 
we will pledge ourselves, unh 

would gladly relinquish a share 

emoluments which they now derive from the n 



PR I Vllr 

management and complication of cases originally sim- 
ple, through the folly of empirics, in consideration of 
.mount of human suffering which would 
be saved if the domain of quackery were limited, by 
Eiision i phyai 1 know- 

tile, then, a large and table portion of One 

uinityares semi? 

. in the management of their health, 
siraUe that th< ' I acquire 

some ki:«>w ledge of the machine upon which they ope- 
and th< thai they emp] 

important arguments 
in in. lical information to 

the public in I. Ev< d in our targe cities, — the 

eentr of the population is \o^ 

n. and too prot 

emer < of a kind neigh- 

■ 
he m 

warn 
demanding 
the 

In the West, — u hi 

iiniinii 
and in such n ad earth are 

id villa 
dation 

rom th( 
►rtanl period in f nil acute dia 

ins arrii al. 
difficull On the 

. a family composed of 
hundred or more individuals. 
a oin th( 

oi the \ ideni almost exclusively upon 

the.agri ulturisl 



Vlll PREFACE. 

cal treatment. It has been truly said that, a little 
knowledge is a dangerous tiling; but certainly, in the 
situation just described, the remainder of the couplet 
is inapplicable. 

Another incalculable advantage which results from 
the extension of correct medical kn vond 

the limits of the pro which it 

throws in tli 
bling the public to jui 
informal ion h the writ* 

arrogance i f those ■.. 
works, to fx rsu 
fering from 

or folly, \ et h< - thai tli 

and tne pn I 

-. ml] with 

(loctniM Tl i •. will tt the 

patient, i : 'us firien 
the practitiom r, an 
distinguish I 

who ha- 
of nmiK 
from Large ci1 

tanong t] 
present ondert ikini 
popular medical g\i 

stance that the 

extant, which c 

present state of tin 

arranged in alphi 

which preoluch i 

recollection t^f the mutual 

strovs that system whi< 

memory, facilitate n rin- 

ciples. 

In executing his task. th< 

conscientiously to iueuleat 

I to secure h 
upon their own parti 
when other ami more effic 
while he lias exerted bin 
form as much condensed as p 



PREFAi IX 

uoii he coii- likely to aid the cause of huma- 

nity under i amble circumstam 

Tilt* fo due to the practi- 

tioners of an honourable profession. To those who 
propose to coin udy of that profession, it 

nay b thai, under the present organization 

our universities and medical i -. the pupil, at the 

moment of entering upon hif rwhelmed 

the (piantr u-ntilic matter forced upon his 

attention by the number and variety of the lectin 

he is called upon to attend. These lectures treat o[ a 

termini if which is 

Unknown to him ; and much iA the value o[ his first 

\x of study is usually lost in obtaining a few gene- 
ral ideas, laborioi - of 
more profound, hut. to him. unintelligible learning. 
,t in perusing and reflecting upon 
the contents of tl >f the present 

ark, will communicate, it is confidently believ* 
Mich broad \ id imp 

physiological, and hygienic bu ill suable 

aim t<» listen with pi. eje to the first 

instruction ; — tic and, to 

man] , almost intolerable portion ^i the 1. I a siu- 

h is n>>w tunc to address the public in 

the design Of the ; work. The 1m -hat 

d individual actually suffering un- 

furse <>f 
Likely t<» prom health, 

and invigorate and pr the force ^\ Ins oonstttu- 

tioi unquestionably, to recommend a con- 

sultation with some deeenredlj eminent physician. 
Hut the directions and reasoning 
better understood bj a patient v. me 

knowledge of the Burst principle a of medicine This 
knowl* rains! the machi- 

oatiom inder-working empim * bo, that 

has the slightest idea of the structure oft lie most OOm- 
pli all the WOT would confide the 

i such a delicate machine i<~> the hands 
n ignorant pretender. 

B 



X PREFACE. 

It is not always possible to obtain the 
ance in due time, and in many situatioi alto- 

gether impracticable to obtain ii at all. There are 
few medical men who have reached midd with- 

out witnessing much misery and i 
suiting from the ill-dir f those wh< 

compelled to act on an emergency 
of a physician. The writer of this t: d ad- 

duce, from personal <•!>• tling in- 

stances of that nature; all < 
prevented by the p 

small share of the informal tiich he trusts may 

be derived from the following pag< 
fore, no intelligent man who may not find 
comfori consulted, and his worn in- 

creased, by studying if 
gj . hygiene, practical medicim 

To heads of families, principals of 
lories, seminaries, and 

foreign stations, and tl 
know ledge is still more import 
" The Medical Friend/' beii 
persede the family physician, bul pply 

Ins place, w hen iti:e nd thai 

practical pari of the work dwells chief -easesof 

an acute character, and thai whenchr. nuts 

are mentioned, directions for the management of the 
ear!i( - have re© the 

after treatment. Thosi liii-li ai 

in their nature, or w Inch d< 

an] stage, ace omitted, or bul lightly touched a] 
and when such remedies or operations as 

ploj ed only by the profession 

remark, the\ troduced mere! 

tural curiosity o( the reader. When, m the cm 

of a case, the requisite treatment becomes 

or demands superior skill, the subjei I - _- nerallv 

fore-closed by referring thi 

dical advisers. 

The work is divided into two parts ; of winch 
first is descriptive and theoretical, the second 



PR] XI 

I11-; desirable that all who would qualify them- 
selves for rightly comprehending the practical part 
should peruse, previously and attentively, the tirst 
four chapters, which may la* regarded as introduc- 
tory 

hmcalities have been avoided throughout the 
nd it ha ideavour of the 

writer to shim whatever pre-euppos - an acquaint- 
ance with medicine or its collateral branches. The 

impossible an] 
derabl iil in the nrsl part, and it is 

that the Style will he found as lighl and cnter- 

is with the gravity and imports 

I '!<• mar 

mtaining a very 
cursory \ id principli 

ti\ nd chapter pr( i more par- 

ticular n< human genera] anatomy » with l)nt 

little that app to the d< partm al ana- 

t"in\ : but, to enliven a [ly considered 

itliarh dr\ 
ally in 

third cha; 

mal tin mi their aber- 

rati The artificial division 

between : I path* rlj 

adopted in th( been h 

calculated Uthouf 

ould be absurd to an 

. w itlnn thrice the compass 
oi the volume now offered to I >lic, and slthoujE 

of application, with all the ad\an1a 8S of a 

thorough eleiiientan edncati aid he ne»a ssarv 

omplete the study, the nevertheless cerlain 

era! principles he utained, which maj be 

easily acquired, and which render the information 

presented in the succeeding chapters much more 
available. The subject is highly interesting in its na- 
ture, and it is hoped that the will find, in the 

entertainment which il funis l ample remune- 

i tor the lahou nl perm 



Xll PREFACE. 

The fourth chapter, on hygiene, or the art of pre- 
serving health, is by no means the Least imparl 
portion of the work, and is worthy the attention of 
every head of a family, or principal of a achooL 
several subjects of food, clothing, air and moisture, 
exercise, the errors of and 

matrimony, are discussed under distincl h< ads Many 
valuable rules for gradually imparting 
constitution, and for the preservation <>f health ui 
atmospheric vicissil r in unhealthy Ritual 

will be found in this chapter. 

The second, or practical poi work Lfl 

vided into live chapters, on the fo] 
jects : surgical accidents and diseases, medical p 
tice, di» ; women, diseases of chile 

and diseases of adult fi It bai 

remarked, that the arpl ed arrangemenl of 

jects lias not heen adopted in any part of this 
but all the conveni* h a distribu- 

tion, may be obtained bj n 

index provided for each of the two gn 

this volume. 

An appendix contains a list n\ man . 

medicines and compound prescriptions recommi 
ed in the work, with the m the 

tatter. It is remarked, thai the mod • 

praclnioners generally employ the smallest nne 
of remedies, as the most able n led 
few implements. 1 then, of following th. 

ample of his predec by perplexing the mini 

his readers with a histon of a great mult 
dicines. the writer has confined his attent 
Of established reputation, and named in I 
the work. 

Having thus narrated the contents of the rohu 
it is proper to mention what portions 
have been performed by the avowed author 
part has heen executed by the pi • 96 
who have aided him in departments to which I 
have devoted more especial attention, tl 
have declined the announcement of their nan 



PREFACE. X1U 

The author is directly responsible for the whole 
of the first part of the work, and for all that is 
strictly surgical in the second part, with the excep- 
tion of the articles hemorrhoids, hip-joint difi md 
white swelling, and the surgical section on constitu- 
tional di 

Tht dicine in modern times has taken 

a ra vnplex in detail, that 

it would be presumptuous in anj one individual, 
w\i may be liis position, to undertake the pro- 

ductionofa workglancii j rly the whole field 

of the theory and practice of medicine, without the 

of those w hoei 
tensive than his <>wn in such departments as be I 
ted by m ai oided by preferen( 

The more cura p ueral the I the m< 

profound is the knowledge required to give value to 
we pages, and oid the danger of serious en 

for, « ben aumerous 1 aticallv e.\ ; 

and arranged, it ia much i i include tnem within 

definite rules, than when tin nlv in the 

tnemorj of one who writes the results of past sttx 
reflection, and experii ark 

bas written — I ions, it 

w as thought advisable that the subject of internal dis- 
should be intrusted to i * hands from 

those which bad been cl with the anatomical, 

physiological, hygienic, and surgical departments. 

The avowed author has addei anal comments 

and incidental r opinions, in the course of 

the Strictl) medical eha; Ins eonnex mn 

with them properly ceased. !!• ta that circum- 

stances induce bis coadjutors to decline the announ< 

ment of their names, and feels that some apolog] 

necessary for the acknowledgment of his own, when 

unattended by theirs The DQOtive nnv be briefly 

stated. 

When a writer presumes to address the public on 

Subjects of high importance, and such as are usually 

regarded as recondite, — especially ifhis subject matter 
drawn I enera] study and experience, without 



XIV PREFACE. 

compilation, or frequent reference to special authori- 
ties, — the value of his labours depends chiefly upon 
his opportunities for the acquisition of inform.v 
and the confidence felt in his mode of employing 
those opportunities. In otln 
character and position are m c 
calculation of the dependence whi' e lldbepli 
upon his dicta. A book upon ;t BCienl t, un- 

supported by any name Lb, tin 
with some suspicion ; and, whethi -hen 

appended, be calculate 
racter, then- is justice in its aimouna men! 

It is true, most of > 
tained in the follov 
common pn >f the p 

wanting frequent individual 
observations, which require a spons 
c\- of their d< duction, or t] i 
meat. No par 
tempted. They will be r< 

who are proficient i such, al< 

the question of their origin is into 

For id the pn >al « ri- 

fcer of the work, has thought i1 incumbent upon bin 
to attach his name to the volume, althoug 
is taken with some reh 

are ihose of his tV:i1« ::nt v. wh< un- 

dertaking ; and partly, because it 
juxtaposition with 

whom to rival, or with whom not 

within the com ins ambition. 

Had the author aimed at reputati might hi 

said much, with justice, in extern] 
style; hut if he have succeeded in - >ook 

o( real utility, hi which 

may flow from it. 

The book is before the public fall 

by its own merits. All that ifi 
tmination. 



CONTENTS. 



Preface, - - - P:< 

PART Mil- 
OUTLINES OP an ITOMY, PHI *D ilvcir.M-:, 10 



i II IPTER I. 

HUE] IBfTNARl riON 

17 



CH MM Kit II. 
nil: HUMAN BODY, - 

. <r udipoae tu*ue, ..... 

I ' aaeoua system, ... - 

.... 

jwular pratcm, anatomy, 

Of the duodenum, - 

Of the liver, ... ... 

Of the small into* 

Of ti. ;ie, ----- 81 

si 

• circulate » • • - • s.M 

irculution, • 80 

-scls, -..-.. go 

lie function of nutrition, ----- 92 

< M' the function of absorption, ----- 93 

< spirution, ------- 

i e apparatus of respiration, ----- 96 

Of secretions, - - - 102 



XVI CONTENTS. 

Page 

Of the urinary apparatus, - 103 

Of the urine, - ----- 106 

Of the skin or integument, - - - 107 

Of the nerves, -- - - - - -111 

Of the brain, - ----- 113 

On the duplicature of certain organs, .... 122 

CHAPTER III. 

PHYSIOLOGICAL REMARKS, - - - - 126 

Of assimilation and nutrition, .... 19(5 

Of the reproduction of parts as displayed in the healing of wounds, 133 
Of symptomatic fever, ..... 

Of irritation and hyper-nutrition, inflammation, physiological, • 147 

Of capillary irritation, ..... 153 

Of nervous irritation, ..... 159 

Of the balance of vital action and re-action, - - - 162 

Of vicarious discharges and transformations of tissues, - - 163 

CHAPTER IV. 

REMARKS ON HYGIENE, - - - - 166 

Offood, - 166 

Of clothing, - - - - - - 188 

Of air and moisture, ...... 

Of exercise, ....... 206 

Of the food and exercise of children, .... 213 

Errors of female school discipline, .... 226 

Of matrimony, ...... ggj 

PART SECOND. 

PRACTICAL DIRECTIONS FOR THE TREATMENT OF 
MEDICAL AND SURGICAL DISEAfi 

CHAPTER I. 

OF SURGICAL ACCIDENTS AND DISEASES, - 
Sect. 1. Of wounds and contusions, .... 

Of incised wounds, ..... 

Of incised wounds of the scalp, 

Of incised wounds of the neck and throat. 

Of incised wounds of the chest. 

Of incised wounds of the abdomen, 

Of incised wounds of the joints, 

Of lacerated wounds, .... 954 

Of contused wounds, - - - . . 

Of contusions, ..... 

Of injuries of the head, .... 

Concussion of the brain, 
Fractures of the skull, 

Of contusions in the cavity of the spine, - - 371 

Of fractures, dislocations/and sprains of the spine, - J71 

Of concussions of the spine, .... 

Of contusions of the chest, .... 



CONTENTS. XV11 

Pnge 

Of contusions of the abdomen, ... 275 

Of contusions of the pelvis and perineum, - - 278 

Fractures of thejxdvis, .... 279 

Of contusions or sprains in the joints, - - 281 

Of punctured wounds, - 283 

Sect. 2. On the dilatation of natural passages, and its consequences, 285 

Dilatation of the anus, - 287 
Of dilated or varicose veins, - 
Of varicocele, ------ 

Of piles, or hemorrhoids, - 

Of dilatations of the heart and arteries, 

Ofaneuri- - 298 

Of aneurismal varix and varicose aneurism, - - 299 

Of mother-spots, or aneurism from anaatotnofi - 300 

Of hernia, or rupture, - .... 302 

Sect. 3. On deformities from imperfect nutrition of the osseous and 

muscular systems, - - - - -311 

Of curvatures of the spine, ... - 311 

Of club foot, . - - - - 318 

Sect. 4. Of fracture- - 319 
Fractures of the clavicle, - 

Fractures of the shoulder blade, - - - 323 

Fractures about the shoulder joint, - - - 323 
Fractures of the arm, - 

Fractures of the elbow joint, - - - - 324 
Fractures of the fore-arm, .... 
Fractures of the lower extremities, 

Fractures of the th .... ggg 
Fractures of the If . .... 
Fractures of the lingers and • 

Fractures of the lower jaw, - 329 

Of dislocation 1, - - - - 330 

Dislocation of the arm into the arm-pit, - - 331 
Dislocations of the v. 
Dislocation of the ankle, with fracture of the fibula. 

Sect. 5. On inflammation and its cooaaonenc 
External inflammat - 

Terminations of inflammation, 

Treatment of inflammation, .... 335 

titration, - 337 
Of ulceration, ..... 

Of gangrene, ------ 342 

-Malignant pustule, ..... 342 

Gangrene of old men, ----- 340 

Dry gangrene, ..... 349 

Gangrene from execs- of inflammation, from internal and 

constitutional .... 343 

Gangrene from pressure, - 344 

^rene from cold, ----- 344 

Gangrene from mechanical injuries, - - - 345 

Terminations of inflammation coupled with collapse, - 340 

Of the sty, ------ 349 

Ulceration of the eye-lashes, - 349 

Foreign substances in the eye, - - - 350 

Inflammation of the eye, - 351 

Ulceration of the cornea, ... - 354 

Films on the eye, ... - - 354 

Foreign bodies in the ear, - 355 

Ear-ache, and suppurations of the ear, - - - 356 

c 



XVlll 



CONTENTS. 



Ulcerations of the mouth, .... 356 

Gum-biles, 357 

Suppurations of the urinary passages, - - - 357 

Excoriations about the mucous orifices, - - 359 

Chafing, ...... 359 

Of abscesses, ...... 359 

Run-round, ...... 361 

Whitlow 361 

Nails growing into the flesh, .... 362 

Biles, 363 

Furuncle and carbuncle, .... 364 

Canker, or gangrenous sore mouth of children, - 366 

Burns and scalds, ..... 368 

White swelling, ..... 370 

Hip-joint disease, ..... 371 

Sect. 6. Corns, warts, and moles, .... 373 

Soft corns, ...... 374 

Warts, ...... 375 

Moles, ...... 375 

Sect. 7. Constitutional diseases, .... 376 

Scrofula, ...... 376 

Of cancer, ------ 378 

Venereal dise;. ----- 880 

Scurvy, - - - - : - 801 

CHAPTER III. 

MEDICAL PRACTICE OR TREATMENT OF INTERNAL 

diseases, ........ an 

Sect. 1. Fever, 387 

Intermittent fever, ..... 886 

Continued fever, - . - - - 393 

Bilious remittent fever, .... 400 

Yellow fever, 101 

Petechial or spotted fever, .... 4(iy 

Sect. 2. Eruptive dit ..... 405 

Small-pox, - - - - - .406 

Varioloid, ------ 409 

Chicken-pox, - - - - - -408 

Cow-pox, .--... 410 
Measles, .--... 

Scarlet fever, ------ 413 

Miliary lever, - ... 415 
Nettle-rash, - ' - - -11'. 

Prickly heat, or lichen, - - - - 417 

Shingles, ..--.. 417 

Ring-worm, - - - - - - 418 

Itch, - - 418 

Rose-rash, ...... 

Gum-rash, ...... 

Pruriginous rash, - 

Sect. 3. Erysipelatous affections, .... 421 

Poisoned wounds, - - - - - 12"J 

Erysipelas phlegmonodes, or diffused inflammation of the 

cellular tissue, ..... K96 

Inflammation of the veins and absorbents, - - 426 

Sect. 4. Diseases of the respiratorv apparatus, - • H8 

Catarrh, - - - - OB 

Influenza, --..-- 430 



CONTENTS, 



XIX 



Pleurisy, 

Lung fever, - 

Consumption, - 

Spitting of blood, 

Pulmonary hemorrhage, 

Asthma, ... 

Angina pectoris, 
Sect. 5. Diseases of the throat, 

Mumps, - 

Quinsy, - 

Croup, - 

Sect. 6. Diseases of the abdomen, 

Cholera morbus, 

Spasmodic or malignant cholera, 

Diarrhoea, or looseness, 

Dysentery, 

Colic, - 

Painter's colic, 

Liver complaint, 

Inflammation of the kidney, - 

Jaundice, 

Passage of gall stones, 

Worms, 
Sect. 7. Diseases of fibrous tissue, 

Rheumatism, - 

Gout, .... 
Sect. 8. Nervous diseases, 

Chorea, or St. Vitus's dance, - 

Shaking palsy, 

Convulsions, - 

Epilepsy, 

Hysteria, ... 

Catalepsy, or trance, - 

Apoplexy, 

Palsy, .... 
Sect. 9. Prominent symptoms and accidents, 

Dropsy, 

Heart-burn, 

Water-brash, - 

Flatulence, 

Costiveness, - 

Indigestion, or dyspepsia, 

Vomiting, 

Hiccough, 

Cramp, 

Bleeding from the nose, 

Strangury, 

Diabetes, 

Gravel, 

Drowning, 

Death from suspension, 



Page 

431 
432 
435 
439 
440 
441 
443 
444 
444 
444 
447 
449 
449 
450 
454 
457 
459 
462 
464 
466 
467 
468 
470 
473 
473 
476 
479 
479 
480 
481 
481 
482 
483 
484 
487 
488 
488 
492 
493 
493 
494 
497 
502 
504 
505 
507 
508 
509 
509 
511 
512 



CHAPTER III. 

DISEASES OF MARRIED WOMEN, 513 
Of pregnancy, and the position and connexions of the child 

in the womb, .... - 513 

Approach of labour, ----- 518 

Of labour, 520 



XX 



CONTENTS. 



Page 

Uterine hemorrhage, - - - - - 526 

Of puerperal convulsions, .... 527 

Inversion of the uterus, .... 539 

Inflammation of the womb, - 531 

Puerperal fever, ..... 532 

Swelled leg, milk leg, or phlegmasia dolens, - - 534 

Puerperal nervousness, mania, and melanchc - 535 

Of palsy of the bladder, .... 537 

Of swelled throat, - 537 

Inflammation and abscess of the mamma, - - 537 

Of inflammation of the nipple, - - . 539 

CHAPTER IV. 

ON DISEASES OF CHILDREN, - - - - .541 

Tongue-tie, --.-.. 

Swelled breasts, ..... 542 

Sore navel, ----.. 

Of the yellow skin and jaundice of infants. . 5 13 

On retension and suppression of urine, 

On painful urination, - 

Incontinence of urine, - 

Excessive urination, urinary consumption, or diabetes, 547 

Sore mouth, thrush, aphthae, - 

Colic, ....... 

Costiveness, ...... 

Vomiting, ...... 555 

Erysipelas, ...... 557 

Dentition, ...... 559 

Worms, ------ 561 

Convulsions, ------ 561 

Dropsy in the brain, - 

Whooping-cough, ----- 5^3 

Inflammation of the tonsils, quinsy, - - • 566 

Cholera infantum, .... - 5^7 



CHAPTER \ 

ON DISEASES OF ADULT FEMALES, 

Appearanco of the menses, 

Chlorosis, or green sickness. - 

Suppression of the menses. 

Obstructed menstruation, 

Painful menstruation, - 

Excessive menstruation, or flooding, 

Final cessation of the mense. 

Leucorrhoea, fluor albus, or whites, 

Pruritis vulva?, 

Falling, or prolapsus of the uterus, 

Retroversion, or fulling of the womb backwards, 

Antiversion of the womb, 

Polypus of the uterus, - 

Cancer of the uterus, - 

Appendix, 

Formulary, 

List of drugs, - 

List of apparatus, 

Index to the first part, - 

Index to part second, - 

Errata, 



574 

576 

580 

596 
599 
601 
607 
615 



CHAPTER I. 



PRELIMINARY REMARKS ON THE ORGANIZATION 
OF ANIMAL?. 



When we look at the wonderful machine which the Deity 
has placed upon the earth to preside over his creation — when 
we consider the beautiful adaptation of its various parts to the 
purposes for which they are designed — we are struck with awe 
and admiration, even upon a superficial glance at its beauty 
and propriety. But when we penetrate beneath the surface, 
and behold the play of its ten thousand arteries carrying sus- 
tenance to every part of the system — the veins returning their 
purple current to the heart and lungs, to be resupplied with 
the elements of life, — when we observe the lacteals taking up 
the nutritious particles from the bowels, and conveying them 
through countless channels to be mingled with the blood — 
the absorbents removing those parts which are no longer fitted 
to fulfil their duty, and the glands rejecting them from the 
body as useless incumbrances, while the vessels again supply 
their place with fresh materials, — when we reflect, I say, that 
this most intricate machine is so constantly undergoing waste 
and repair, that in a very few years it loses every individual 
atom which formed a part of its original structure, while it 
still preserves its form and motions unimpaired, we are lost 
in wonder; not less at the wise ordinations of Nature that re- 
gulate its operations, than at the audacity of those who dare 
to interfere with her arrangements, even when disorder is 
perceived among the wheels and springs of this masterpiece 
of Divine wisdom and power. 

But Nature governs all her works by a few simple laws ; 
and when these laws are discovered, the explanation of her 
most involved phenomena are often brought within the grasp 
of human reason. By contemplating the fall of an apple, New- 
ton was enabled to expose the hidden cause of all the move- 
ments of the heavenly bodies. Now, although we have not 
arrived at nearly the same simplicity in the study of the sci- 
ence of life which that philosopher has reached in speculating 

3 



18 OUTLINE OF ANATOMY. 

- 

on Natural Philosophy, we have discovered many general 
principles which shed no inconsiderable light on the other- 
wise incnm pre flexible operations ofihe human frame in health 
cnl in disease. Let us, then, proceed to elucidate these prin- 
ciples, as far as the limits and the object of this work will per- 
mit.' 

The simplest of .ill animals — which mostly reside in the wa- 
ter — appear lo be entirely divested of feeling, or voluntary mo- 
tion ; they have no blood vessels, no nerves, no intestines, no 
organs; they are composed of a kind of membrane containing 
'many cells and fibres of different shapes and sizes, filled and 
surrounded with a peculiar fluid. In structure they are not 
unlike a sponge, enclosed in a bladder of the same substance, 
and shaped into different forms according to the species. In 
composition this membrane does not differ verv widely from 
the white of an egg when boiled. Such is the picture of the 
simplest specimens of animal life, and although the labours of 
recent naturalists have proved the existence of more complex 
organs in many of the tribes of minute beings, whose existence 
is scarcely perceptible, except by the aid of powerful micros- 
copes, there are not wanting many of much larger size, and, 
therefore, open to accurate observation, in whom the whole 
body is devoid of any systematic arrangement, other than that 
which has been just described. 

These animals live by imbibing their sustenance through 
the skin from the fluid in which they swim, and as they select 
such particles as are fitted to their wants, they may be said 
to perform a kind of external digestion. The membrane of 
which they are composed is supposed to contract when touched, 
and also, when acted on by light, heat, electricity, and, perhaps, 
other causes; thus the fluids which it contains are agitated and 
moved from place to place, so that an imperfect kind of circu- 
lation is effected without the aid of blood vessels, and all parts 
of the body are nourished and furnished with the means of 
growth. If respiration be necessary to these animals, it must 
be effected by the external surface, and whatever matters re- 
quire to be ejected from the body are compelled to pass by the 
same route. This substance, of which they are composed, and 
which is called cellular membrane, or cellular tissue, seems, 
therefore, to be capable of fulfilling all the functions of life, as 
far as they are necessary to the existence of the most simple 
animals, and, strange as it may appear, even the human em- 
bryo, when it first becomes visible, and for some time after- 
Ward, cannot be distinguished from a small mass of cellular tis- 
sue! Although it is obvious that it must be endowed with life, 
it contains no vessels nor organs, but resembles a mere piece of 
animated jelly. 



OUTLINE OF AN ATOM V. 19 

When we begin to examine animals more and more ad- 
vanced in the scale of nature, we rind that those which are de- 
signed to move about in search of food, instead of having their 
food brought to them, require to be furnished with organs 
especially devoted to this purpose. They have muscles: for 
the occasional, and, as it were, accidental contractions of the 
cellular tissue are too irregular and uncertain to answer their 
necessities, and they require an apparatus for locomotion. 
From the moment that the character of perfect simplicity is 
thus lost, it seems that mere absorption from the surface is in- 
sufficient to supply the materials for the different organs, and 
the animal is supplied with an internal cavity or stomach, and 
bowels more or less complex in structure, in which food may 
be enclosed until it can undergo a more careful and deliberate 
digestion. Still these muscles, of which we have spoken, 
though they look like fibres of considerable length, are thought, 
by most, to be in reality composed of globules or particles, 
ranged in rows in the midst of the cellular tissue, which ties 
them together in bundles and keeps each particle in its proper 
place; they are strictly interstitial deposites, rilling the cavities 
and adhering to the layers of the membrane. 

Now the movements of the muscles would be embarrassed 
and, perhaps, destroyed, if the liquids which support life were 
permitted to pervade the whole body, in these, as they do in 
the simplest animals, which have no well defined organs; the 
nutritive fluid or blood, is, therefore, generally enclosed in 
distinct vessels, formed ultimately of the same cellular tissue, 
but having no communication with its cells. These vessels 
divide and redivide, carrying the blood to every part of the 
body, and returning it again to a reservoir, or Heart, which 
forms the centre of the circulation. 

As every part of the body receives its nourishment from 
the blood, it is obvious that this fluid is constantly undergoing 
considerable waste; nature has, therefore, provided a system of 
vessels which is rather an appendage to the circulatorv ap- 
paratus than a part of it. These vessels, which physicians 
call the Lacteals, arise in countless numbers from every part 
of the bowels. They take up, by some invisible means, such 
parts of the food as are suited to enter the blood, leaving the 
rest to be ejected from the body by the natural passages. 
They pursue a winding course, uniting gradually with each 
other, and thus becoming larger, as the little streams from a 
thousand springs are slowly collected first into rivulets, then 
into brooks, until, at length, they give rise to a noble river* 
The river of the lacteals into which they are all finally col- 
lected is, in man, a vessel about as large as a crow-quill, which, 
running for some distance along the spine, near the back part 



^0 OUTLINE OF ANATOMY. 

of the chest, empties its contents into one of the principal veins 
of the body just before it enters the heart. 

The Heart is a strong hollow muscle, which alternately 
receives the blood as it flows toward it, and then forces it by 
a strong contraction through vessels, which go on continually 
branching until they reach every part of the system, like the 
limbs and twigs of a great tree. 

The principal trunk and great branches of this class of ves- 
sels are termed Arteries; the blood is propelled through them 
chiefly by the direct force of the heart, but they are provided 
with a coat or envelope of fibres resembling those of muscles, 
which aid in urging the current more uniformly in proper di- 
rections, and as the arteries grow smaller, these fibres increase 
in their relative strength, as the bark of the smaller twigs be- 
come thicker in proportion, than that of the body of the tree. 
At length these little arteries become capable of hastening or 
retarding the flow of blood, and sometimes, perhaps, they check 
it altogether for a moment. They now change their name, 
and are called the Capillaries. 

It is through the capillaries that all those particles which are 
required for the growth and preservation of the body and its 
several organs, are separated from the blood and placed in 
their proper stations. The same vessels are supposed by some 
to take up and mingle with the blood those particles which 
have done their dutv and are worn out in the service, in order 
that they may be disposed of, in the manner in which most 
bodies corporate reward the past services of friends no longer 
found necessary; that is, by being turned out of doors. In 
this most thankless duty, however, they are certainly aided by 
a subsidiary class of vessels called the Absorbent?* which con- 
vey only colourless fluids collected from all parts of the b 
Most of these last named vessels, finally empty their contents 
into the common trunk of the lacteals, and thus into the veins; 
but some of them reach the same destination by a more direct 
route. 

This constant addition of nutritive matter to the blood by 
the lacteals, its distribution to every organ of the animal by the 
heart and arteries, its separation from the mass of circulation, 
and its application to the growth and repair of all parts by the 
capillaries, together with the removal of injured, useless, or de- 
bilitated particles by the absorbents, are subjects connected with 
the all-important process of nutrition. 

After the blood has passed the capillaries it falls into ano- 
ther system of vessels called the Veins, bv which it is returned 
to the heart. The veins are destitute of the seemingly mus- 
cular coat of the arteries and capillaries, and although the 
blood is constantly pushed into them bv the joint action of 



OUTLINE OF ANATOMY. 21 

the heart, the arteries, and the capillaries, they are unable to 
propel it by any effort of their own; they are mere passive 
conduits. To supply this apparent defect, they are provided 
with numerous valves, set here and there along their course, 
which permit the blood to pass toward the heart, but prevent 
its return in the opposite direction. By the constant motion 
of the muscles in breathing, walking, coughing-, sneezing, &c, 
the veins are very frequently Compressed, and their contents 
urged forward more rapidly; hence the healthfulness of exer- 
cise and gymnastics, but of this I shall speak more fully in the 
chapter on Hygiene. All the veins of the body are gradually 
collected into a few great trunks or canals, which pour their 
contents into the heart, and those which belong to the general 
circulation, — that circulation which is destined to supply nutri- 
ment to the body — form, in the more perfect animals, two great 
conduits; one coming down from the head and upper extremi- 
ties, the other coming up from the trunk and inferior ex- 
tremities. These conduits meet directly end to end, so as to 
form but one trunk, which opens into the heart by a gap at the 
side. 

The blood thus returned is of course altered, in the first 
place, by having parted with a great deal of matter for the 
repair and growth of the different organs, and secondly, by 
being loaded with all the useless particles which the absorbents 
have taken up. In order then that it may be fitted for circu- 
lating again, it must receive considerable additions and it must 
cast off considerable impurities. The former are supplied by 
the lacteals, but the latter process requires a different set of 
vessels endowed with other powers. 

One of the chief impurities which the blood receives from 
the absorbents is carbon or charcoal. To rid it of this, a part, 
and in the more perfect animals, the whole of the blood, is 
made to pass through an organ where the vessels come almost 
into contact with the element in which the animal lives, as 
the water in fishes, and the air in birds and man. Both these 
elements contain oxygen or vital air, and by some hidden 
means, the carbon of the blood, being supposed by most to 
unite with this vital air, escapes through the thin coats of the 
vessels in the form of carbonic acid gas, the same gas that rises 
from fermented liquors, soda water, &c. Thus, we see some 
animals breathing water, and others, air. The former, gene- 
rally have the breathing organs placed externally; they are 
termed Branchiae or gills; in the latter, they are situated within 
the body, and are called Lungs, or lights. The function per- 
formed by these organs is called respiration 

It is believed by many physiologists that nature, always un~' 



22 OUTLINE OF ANATOMY. 

willing to perform any useless labour and anxious to effect as 
many operations as possible with a very few materials, has so 
ordered the laws of respiration that it shall preserve the 
warmth of the animal at the same time that it purities the 
blood. While the blood is acted upon by the atmosphere in 
the lungs, or hy the water in the gills, it is supposed to absorb 
a great quantity of heat, and as it flows towards every part of 
the body, undergoing a gradual change, it is thought "to throw 
out this heat, and thus to keep every part at its proper tem- 
perature. 

The effects of respiration are not sufficient to remove all the 
impurities of the blood, and, therefore, a number of curious 
organs, called Glands, are provided, some of which aid in sepa- 
rating many of these impurities, each gland furnishing its own 
peculiar fluid, which it pours out either into the bowels or 
into the skin. The product of many of these glands is made 
useful for various purposes before it is thrown off from the 
body; thus the liver, the largest of the glands, forms the bile, 
which is the natural purgative, producing, when healthy, regu- 
lar and comfortable stools; and when diseased, occasioning cos- 
tlveness or bowel complaints: the pancreas and the glands 
about the mouth pour out the spittle which assists digeNtion. 
These useful fluids are called Secretions, but those which are 
ejected, like the urine, without fultilling any important purpose, 
are called Excretions. 

From what has been said, it is obvious that the motions ne- 
cessary to main tain life even in very simple animals are nu- 
merous and complex. The stomach and intestines mu<t re- 
ceive and digest food; the lacleals must take up the nutritious 
part of the food and carry it to the blood; the arteries must 
convey this blood to the different organs; the capillaries must 
supply the growth and waste of those organs; the absorbents 
must aid the capillaries in taking away the worn out and use- 
less parts to mingle them with the blood in the veins; these 
vessels must convey the blood back to the heart, which must 
then pass it to the lungs to be deprived of some of its impurities, 
and to enable it to sustain the heat of the body. In addition 
to all this, the glands must assist in purifying the hlood, or they 
must furnish fluids to aid in digestion and other functions, or to 
purge away those useless remains of the food, which cannot be 
digested. So many different motions all dependent on each other, 
would necessarily produce continual confusion, by acting irre- 
gularly and to cross purposes, if thev had not some common 
bond of union by which they can mutually inform each other, 
as it were, of their several wants and actions. This bo: 
union is furnished bv the nerves. 



OUTLINE OF ANATOMY. 23 

In the more simple animals, we find only a few nervous 
fibres running: in different directions, with here and there lit- 
tle knots called Ganglions, joining several fibres together. 
When any impression is made upon one of these fibres, it is 
instantly communicated to the parts with which it is connect- 
ed, and" calls them into action. If the fibre is united with 
others, or with one or more of the little knots just mentioned, 
they are also called into action, and several different parts are 
then put in motion at once. Thus when food enters the sto- 
mach, its nerves receive the impression and cause the capil- 
laries of that organ to dilate in order to receive the blood 
required to carry on the process of digestion; they also give 
notice to the heart, which, if necessary, acts with more force 
in hastening the circulation, and the capillaries of the skin 
contract and drive the blood from the surface toward the 
bowels. This is the cause of the slight chill and consequent 
fever so often felt during and after a hearty dinner. The ani- 
mal, however, remains unconscious of all this hurry of business 
within, and the nerves which are the messengers and agents of 
the manufactory are called the nerves of organic life. They 
are altogether independent of the will, and are found in ani- 
mals supposed to have no brain. 

In beings of a higher order, that are obliged to choose their 
food with judgment, and to travel far in search of it, other 
nerves are required to enable them to recognise its presence; 
these are the nerves of sensation. There must also be a brain 
to enable the animal to judge of its impressions, and to per- 
ceive its wants, and another system of nerves is required to 
pass from the brain to the different muscles, by which the 
former may direct the motions of the latter; these are the 
nerves of voluntary motion. All these several systems, though, 
in some degree, independent, are connected together by the 
brain and the little knots or ganglions, so that they mutually 
influence each other. 

Finally, to enclose and protect this multiform and delicate 
structure, there is a coat of condensed cellular tissue cover- 
ing the whole body, and called the true skin, over which is 
spread a thin layer of horny matter called the cuticle or scarf 
skin. This cuticle is totally insensible, and forms a mere 
crust which protects the delicate and exquisitely sensitive sur- 
face of the true skin. The horns, nails, hair, spines, shells, 
and crusty coverings of various animals, are all classed pro- 
perly with the cuticle, being either excrescences of, or substi- 
tutes for, that membrane. 

Each of the parts of an animal that have now been enume- 
rated may be found even in a common snail, or in the mean- 
est of the reptiles ; but, as we ascend in the scale of nature. 



24 OUTLINE OF ANATOMY. 

every system of organs is observed to become more and more 
complex in structure, and capable of actions more and more 
various. 

Man, the most perfect Gf animals, not only requires the 
whole of this complex apparatus, but his brain also contains 
systems of nervous fibres, for the exercise of the higher in- 
stincts, moral feelings, and reasoning faculties. He is at first 
nothing but a little mass of cellular tissue ; but as the infant in 
the mother increases in size, one organ is added after another, 
nearly in the order described, and many of his parts do not 
reach their full development until he approaches middle life. 

We will now proceed with a hasty review of the several 
parts and systems which compose the human body, with such 
notice of their action as our narrow limits will permit, pur- 
suing the order in which we have already arranged the prin- 
cipal functions which belong to all animals. 



OUTLINE OF ANATOMY. 25 



CHAPTER II. 



STRUCTURE OF THE HUMAN BODY. 



In describing a machine composed of a thousand parts, all 
so connected that they cannot act separately and independent- 
ly, but must mutually assist each other in every operation, it 
is extremely difficult to select a point from which to commence 
our narrative. We shall he occasionally compelled while de- 
scribing one organ or one system, to speak of others, that have 
not been brought before the reader. When treating of the 
nature of the muscles, for instance, we cannot avoid alluding 
to the nerves from which they derive their power. But it is 
hoped that the general view contained in the previous chapter 
will render the contents of the present sufficiently intelligible. 



OF THE CELLULAR TISSUE. 

If it were possible to remove from the body every thing 
which gives to each of the different organs its peculiar cha- 
racter; if we were to take away all the hard parts of the bones, 
all the red parts of the flesh, all the pulpy parts of the brain 
and nerves, &c, we should still find the form of the body pre- 
served. It would then be converted into a simple mass of cel- 
lular membrane, containing the same cavities which we see in 
the perfect body; but most of the places from which the par- 
ticles of the organs had been removed, would be too small for 
the naked eye to detect them. Now, it has been already 
mentioned that this membrane appears to form the whole 
body of the child when it first becomes visible a few weeks 
after conception. It is, therefore, the foundation of the whole 
structure of man. Its cavities form his blood vessels; its outer 
surface is the skin, and its inner surface, the bowels; and all 
the different organs are made up of matters deposited within 
its little cells. 

4 




26 OUTLINE OF ANATOMY. 

Cellular membrane, when carefully examined, is found to 
be formed entirely of innumerable little fibres, of every varie- 
ty of shape and size, running together in every possible di- 
rection, so as to form a mass very similar to a common sponge, 
but with intervals extremely small in most places. These fibres, 
under the microscope, appear to be ultimately composed of glo- 
bules like those of the muscles, but this subject is still involved 
in doubt. The marginal fig. I. represents 
this appearance. In some situations these 
fibres are narrow, loose, and comparative- 
ly distant, like the meshes of a net, in 
others, they are broad and close, so as to 
form partial cells, which communicate 
with each other on all sides. The sides 
of these cells and the meshes of the net- 
work just mentioned, are prevented from 
•adhering together by a fluid formed out 
from the membrane itself, or from the 
Mood vessels, which keeps them always moist, and when this 
fluid becomes too great in quantity, in consequence of disease, 
the patient labours under general dropsy. The swelling of 
the feet when standing, and their return to the proper shape 
during the night, so often noticed in weakly persons, furnish 
a beautiful proof both of the existence of this membrane and 
of its peculiar structure, which allows the fluid to flow from 
cell to cell until it settles in the lowest point, 

But if the cellular tissue were every where open and penetra- 
ble to this extent, it is evident that it could neither confine the 
blood and other fluids in their proper course, nor could it ef- 
fectually support the various organs in their correct position. 
Moreover, where one part is intended to slide over another, as 
it is the case with the bowels, for instance, which are constantly 
changing their size and position as the food passes through them, 
would be very inconvenient to have these parts tied together 
by close cellular tissue, for this bond would either prevent 
their proper motives, or it would be continually stretched and 
torn by them. 

To avoid these difficulties, nature has modified the arrange- 
ment of the cellular tissue in different parts of the body, in 
several ways. In some places, the sides of the adjoining cells 
are united together over a considerable space, so as to form a 
broad sheet of membrane, through which fluids cannot pass; 
and these sheets are applied on those parts which are intended 
to move upon, or glide over each other. Thus, the bowels 
are covered by such a membrane, which is united to them by 
loose cellular tissue on one side, but on the other* remains 
perfectly smooth. After covering each bowel, like an over- 



OUTLINE OF ANATOMY. S7 

coat, it passes in a double sheet to the spine, and spreads itself 
out on each side, so as to form a lining to the whole inside of 
the abdomen or belly — the cavity in which the bowels are 
placed. — Oneof these membranes exists ineach of the great cavi- 
ties of the body; in the head, to facilitate the motion of the brain; 
in the chest, to allow proper play to the lungs, and in the ab- 
domen, to hold the intestines in their places without preventing 
them from receiving and expelling their contents by their pe- 
culiar movements. 

The same arrangement is noticed on a smaller scale in some 
other parts of the body, but the three instances just given, are 
the most important. These membranes are called the Serous 
Membranes, and the sacs formed by them are called the Ner- 
vous Cavities. They may be regarded as so many vast cells 
of the common cellular tissue, not communicating with the 
neighbouring cells, but completely closed on all sides. As 
we have compared the cellular membrane, in general, to a 
sponge, we may now compare the serous membranes to as 
many wet and empty bladders spread through the substance 
of the sponge, to which they are glued fast on the outer side. 
Their chief object is to prevent friction. They are kept al- 
ways moistened when in health, by a serous fluid very simi- 
lar to that which is found in the smaller cells, but when this 
fluid collects in too great quanlity it cannot subside toward 
the feet as it does in general drops} 7 , but remains shut up in 
the sac, forming a dropsy of the belly, of the chest, or of the 
brain, according to the cavity in which the disease is seated. 

Every moveable joint in the body is provided with a simi- 
lar sac or bladder, which lies between the ends of the different 
bones, or rather, between the caps of cartilage or grizzle 
which covers them. The fluid contained in the cavities of 
the joints differs a little from common serum, and answers 
the same purpose with the oil used in machinery to prevent 
friction. 

In many places, where a number of different muscles are 
frequently called into action at one time, they require to be 
bound down firmly, to prevent them from getting out of place 
when the limb or member changes its position. This is ef- 
fected by another arrangement of the cellular tissue; by which 
a considerable portion of this spongy matter is compressed 
into the form of an apron, the cells being nearly or entirely 
obliterated, and the whole texture of the part rendered firmer 
by an increase of the number and strength of the fibres, which 
seem matted together like tangled hair. Membranes of this 
kind are connected with the general cellular tissue on both 
sides. When large and broad, they are called Fascix. One of 
the best marked fascia? in the body, covers and binds down the 



OU T -TOMT. 

muscles of the thigh, and, were it not for its presence, the 
thousand graces of :s or Tagliost would be converted 

into horrible deformity by the muscles, which would start up 
like cords at every change of the dancers position, until all 
symmetry would disappear. Some of these fasciae evidently 
resemble the general cellular tissue, simply condensed to a 
greater or less degree; almost every muscle, and many of the 
important blood vessels and nerves are completely surrounded 
by sheaths of this nature, more or less delicate in structure. 
The true skin, as we shall see hereafter, is formed in a ve: 
milar manner, but when membranes of this class are very 
strong, like those which bind down the tendons of the 
and hand, they begin to appear more distinctly fibrous, to the 
naked eye, and in the proper ligaments which bind together 
the different bones, the cellular character is so completely lost 
or hidden that considerable care is required to demonstrate 
its presence. One of the closest and firmest of the membranes 
formed from the cellular tissue is that which covers the bones, 
and is called, by anatomists, the periosteum. It is necessary 
that it should be very strong and close, for, if it were to slide 
ever so little, in consequence of blows or other injuries, the 
▼easels which pass through it to feed the bone beneath, would 
be torn off, and a part of the bone would be liable to die or 
mortify, for want of support Yet, even this periosteum, 
fibrous as it appears to be, is really cellular, and when a bone 
is broken, we see its cells dilated and enlarged, until the mem- 
brane becomes soft and pulpy, and ofter. .imes as thick 
as it is in common, in order that its blood vessels may be al- 
lowed to enlarge and to make room for the bony matter ne- 
cessary to mend the fracture. 

To prove the existence of the cellular tissue in the substance 
of all the different organs, is a task of some difficulty, and al- 
though it has been demonstrated, again and again, by modern 
anatomists, neither the limits of this work nor the patience of 
its uninitiated readers, will warrant us in pursuing the detail. 
It is hoped, that what has been said, will suffice to give a clear 
idea of the nature of this fundamental tissue, and whatever 
additional information is found necessary to our purpose in 
writing a popular treatise, will be given under other appro- 
priate heads. 

The cellular membrane is not very liable to disease, except 
when it contains other matters than those which belong to its 
own proper texture, and when it is formed into distinct or- 
gans, such as we shall presently describe. The history of 
those animals which appear to be entirely composed of it, is 
so little known that its vital actions can hardly be ascertained 
by observations made upon them: and in the human body, it 



OUTLINE OF ANATOMY. 29 

is so involved and concealed by the operation of other more 
complex parts, that it is difficult to ascertain its independent 
agency. It is liable to become diminished or increased in 
bulk, by the increase or diminution of its contents, and pro- 
bably, by the absorption or unnatural growth of its own sub- 
stance also. When it contains other solid substances, as in the 
muscles or bones, these may be removed by disease, and the 
part may be reduced to simple cellular tissue, and when in- 
juries have destroyed a portion of bone, or muscle, the neigh- 
bouring portions of this tissue are capable of transforming 
themselves in time, so as to supply the deficiency. When 
any part of the body is cut away, the wound heals first by the 
development, or, if necessary, the reproduction of a portion of 
this tissue, which afterwards receives, more slowly, the pecu- 
liar character of the part removed. This reproductive power 
is observed to increase as we descend in the scale of nature, 
toward animals of more simple structure: thus, lizards and 
lobsters, when one of their limbs is cut off, renew it in a 
short time; and among the worms, when cut in half, we some- 
times see each half forming a perfect animal. In man, how- 
ever, this power is so limited that some eminent physiologists 
deny its existence, but the weight of sufficient authority is not 
wanting to prove the correctness of the views just stated. 

The cellular tissue frequently mortifies, and comes away in 
large pieces through openings made in the skin, as often hap- 
pens in the worst forms of erysipelas, but this appears rather 
to result from its being cut off from its proper supply of nou- 
rishment, than from any diseased action of its own — and it 
happens much more readily, where the tissue is soft and com- 
pressible, than where it is much condensed and firm. 

OF FAT OR ADIPOSE TISSUE. 

Fat is an animal oil, which is secreted in very minute drops, 
each shut up in a separate cell, composed of membrane so ex- 
tremely delicate, that its existence is scarcely perceptible. 
These cells are supposed, by many, to be perfectly closed, 
but their structure has never been fully demonstrated. Seve- 
ral drops, with their envelope, are again surrounded by a simi- 
lar membrane, but a little thicker; a number of these primara- 
ry groups are again collected under a still firmer covering, 
and so on, until considerable masses are formed, which are 
held in place, by the common cellular tissue, in the cavities of 
which they are placed. 

Most physiologists consider this membrane as distinct from 
the cellular, and call it the adipose tissue, but their position is 
hardly sufficiently established 



30 OUTLINE OP ANATOMY. 

Masses of fat are always found in particular parts of the 
cellular tissue, where they sometimes serve the purpose of 
cushions, as is the case under the skin of the palm of the hand, 
and sole of the foot. Very often they seem designed to give 
bulk, freedom, and symmetry, to important parts, which are 
complex in structure, as in the female breasts, and many other 
glands. 

But one of the most important uses of the part, is to supply 
the system v/ith support, when, in consequence of the depri- 
vation of food, either from loss of appetite, in disease of the 
bowels, or from hard necessity, the natural supply is cut off. 
Thus, we find that more bleeding, and a longer continuance of 
low diet, is generally necessary, when inflammation attacks 
persons in high keeping, than when it occurs in those who 
are lean, and have no such reservoir within themselves. 
Much of the fat is taken up by the absorbents during long 
sickness, and is conveyed by them into the blood, so as par 
tially to supply the want of chyle; and this is the chief cause 
of the " falling away " of the person under such circum- 
stances. 

The adipose tissue is liable to few diseases, but when it is 
deposited in too great amount, it is often found in the condensed 
cellular tissue, where nature never designed that it should 
appear. It then softens these more solid parts, and produces 
general weakness, so that very fat persons are rarely healthy. 
Sometimes it collects in masses, out of its proper place, and 
forms tumours, which may reach a great size, but they are 
not dangerous unless they prevent the proper action of the 
neighbouring parts. They are different from wens, and gene- 
rally occur in many places at one time, and they should not 
be meddled with, unless they give considerable inconve- 
nience; in which case, an experienced surgeon can, at once., 
determine the propriety of cutting them away. 



OF THE LOCOMOTIVE APPARATUS. 

The locomotive apparatus, or the organs of motion, in man, 
are composed of two different systems of organs: 1st. The 
bones, or osseous system, with the Ligaments, which tic the 
different bones to each other, and assist in forming the joints. 
2ndly, The muscular system, with the parts accessory to 
the muscles, called Tendons. 

These organs are not all exclusively employed in moving 
the animal at will, from place to place, for many of them as- 
sist in producing internal motions, which are so necessary to 
life, that they are removed partly, or entirely, from the go- 



OUTLINE OF ANATOMY. 31 

vernment of the will. Besides those just enumerated, there 
are some other structures which aid in effecting or regulating 
these involuntary motions, and, yet, are not now generally 
acknowledged to be muscles, although they were formerly 
ranked as such. I shall speak of each of these systems sepa- 
rately. 

OF THE BONES, OR OSSEOUS SYSTEM. 

Among the very small and simple animals, whose move- 
ments are few and of but little extent, there is no skeleton; 
their muscles are simply attached to a hardened skin, or to 
each other, so as to draw different parts together; and by thus 
bending the body, to roll, push, or tumble it about. This ar- 
rangement we see in many marine and some land worms. 

When we ascend a little in the scale, we come to animals of 
a more complex shape, and more various powers. They re- 
quire some firmer support to the muscles, and then we see, 
either one or more solid external crusts serving, both for bones 
and a house, as in the shells; or we find the body and limbs 
enclosed in rings jointed together, so as to form a complete 
external skeleton, as in insects and crabs. But man could not 
exist, if constructed on either of these modes; his size, his 
energies, and his wants, all demand that his body and limbs 
should be moveable, and possessed of sensation in every part, 
and he is, therefore, endowed with internal bones. 

When they first become perceptible in the infant, before 
birth, the bones are all soft and pulpy, being composed — like 
the rest of the body at a still earlier period — of simple cellular 
tissue, with its cells filled with a kind of glue: but most of 
them soon become converted, to all appearance, into cartilage, 
or gristle, by the deposition of another kind of harder matter 
along with the gluten in the cells. After a time, we find 
earthy matter or true bone, thrown down, at first irregularly, 
in different spots, within what is generally called the carti- 
lage of each bone. These spots go on continually increasing, 
and the earthy matter at length becomes so considerable, in 
amount that the cartilage is no longer visible. The bone is then 
perfectly formed. This process is not completed in all parts 
of the skeleton until the child approaches to manhood, and 
happy indeed is the effect of this arrangement! for the long 
bones of young persons being partly cartilaginous, may yield 
to a certain extent without breaking, and before the fifth year, 
we not unfrequently see the limbs bent to a great extent with- 
out fracture. Children are so very liable % to falls, that this 
yielding of the bones very often prevents more serious in- 
jury, 



32 OUTLINE OF ANATOMY. 

Even in the grown man, the cartilaginous part of bone is 
not entirely removed: only a part of it is taken up by the ab- 
sorbents, in order to make room for the earthy matter, the 
particles of which are glued together by the remainder, to 
which gluing the parts owe all their strength. When a bone 
is soaked in a strong mineral acid, very nearly all the earthy 
portion is removed, for it is nothing but a salt of lime; vet 
the bone retains its shape, being then composed entirely of 
the remaining cartilage, and it may be bent in all directions 
without breaking. On the contrary, when the bone is heated 
for some time in a furnace, very nearly all the soft matter, 
namely, the cartilage and cellular t: turned out; yet it 

is not changed in form: the phosphate of lime preserves its 
shape, but the particles adhere they m 

crumbled between the fingers. 

Bone, then, or as it is called by anatomists, tl s tis- 

sue, is composed of the fundamental cellular I cells 

distended, at first, with a glutinous fluid, afterwards with a 
substance resembling cartil ristle, to which it owes its 

elasticity, and at I Mill later period, a part of this ! 
moved and replaced by phosphate of lime, which gives it its 
characteristic hard; 

The precise mode in which the particles of the two diffe- 
rent depositee just mentioned are arranged in the cellul. 
sue, M not precisely known; but we will now proceed to 
mine the structure of the bones when fully formed, as they 
appear to the naked I 

When you first look at one of the long bones, it seen 
be formed of a great number of threads or fibres rum 
by side: but this appearance is deccpt'r. 
shows 01 that these seeming fibres are constantly runnit | 
gethcr and dividing in every direction, and that th 
irregular in size and length as in position. When a similar 
bone is broken by the hammer, particularly after ii has been 
long exposed to the air or to fit s off in such a man- 

ner as to induce the belief that it is composed of layers or 
strata placed one over another; but tlii > 

more careful examination shows that these t. icy have 

been termed by some anatomists, arc com pi tctl with 

the surrounding parts by bony matter, a little less conden 
and that they have no regularity of form, thickness, or direc- 
tion. 

The best mode of acquiring a tolerably clear idea of the 
structure of bone, is to pass a saw, lengthwise, through one ot 
the principal lon^; bones of some animal, while i 
We find it composed of a eylim J, en- 

larging and becoming softer as it approaches the 



OUTLINE OF ANATOMY. 



33 



form the joints. Each of these long bones is originally com- 
posed of at least three pieces, the shaft and the two extremi- 
ties, which do not fully unite until the animal approaches to 
its full growth. The extremities are composed of a thin outer 
crust, or covering, which resembles a membrane converted 
into bone; within, they consist of a great number of small cells 
and short fibres, as if formed of a portion of common cellular 
tissue rendered solid and hard in the same manner. The ends 
of the shafts resemble the extremities very closely; but as we 
carry our observations toward the middle part, we see the 
bony cells and fibres growing larger and fewer in number, 
and the external hard covering, thicker and stronger, until, in 
the centre of the shaft, we and a large cylinder, generally 
without any hard cells or divisions, enclosed in a bony case, 
which, at first sight, appears to contain no cavities within its 
substance. It seems as if the cellular tissue, which is loose 
and free in the extremities, were compressed and flattened 
down in the shaft by the growth of the cavity within, and 
the resistance of the membrane without, until the cells are 
nearly obliterated, and the whole mass converted into one 
solid bony fascia by the cartilaginous and earthy matter 
thrown down into it by the blood vessels. (I 

If wc n ride of the shaft cross- 

ihlll find that the hard case, just 
not perfectly solid, but that it 
infl many small and eloni ities, 

which prove that the original cellular tis- 
sue is not (l« : and the whole bone 
may be again reduced to that simple condi- 
tion by the careful removal of the earthy 
and cartilaginous particles. The method 
of pi fact, cannot be described, 
with propriety, in a popular work. 

All the cavities, whether in the extremi- 
the central canal, or the hard covering 
of the shaft, are filled with a still more de- 
i portion of cellular tissue with its 
distended by a substance resembling a 
sofl fit. well known under the common 
name of / tow. 

The flat bones, such as those of the ribs, 
fee, and the shoit bones, as those 
of the spine, i formed in precisely 

the same manner with the extremities of 
the long bo Those of the head, 

however, have been described by most 
anatomists as different in their arrange- 




34 OUTLINE OF ANATOMY. 

ment — this is a mistake; for the only peculiar circumstance ob- 
servable in the growth of the bones of the head, is this; 
the cartilaginous and earthy matters of these bones are thrown 
down together, so that they are tolerably hard from the first, 
but the earthy particles are placed, and remain so widely- 
parted until long after birth that these bones may be consi- 
derably bent, in children under a year old, without being com- 
pletely broken. The necessity for this hardness of the bones 
of the head before birth will be plainly perceived, when we 
have considered the structure and uses of the skeleton. 

The bones, thus organized, are provided with blood vessels, 
which are of course accompanied by nerves. They are 
therefore living organs; but, in a state of health, they have 
very little sensibility; when they are diseased, however, they 
are often the seat of excruciating pain. 

The same remark will apply to the membrane containing 
the marrow. It is a common prejudice, that this marrow is 
exquisitely painful when touched, as in amputations; but, 
when healthy, it may be torn or cut almost without the injury 
being perceived by the patient for, in this respect, it does not 
differ from the general cellular tissue of which it is a portion. 

The lower parts of the skeleton, such as the small, and most 
of the flat bones and the extremities of the long bone- 
much more fully supplied with vessels and nerves, than the 
shafts of the long bones. For this reason, when inflammation 
attacks the former parts, it is apt to produce either an abscess 
or an ulcer, but when it affects the latter, the I more 

frequently a mortification or absolute death of a part of the 
bone. 

Bach of the bom I nallv by a very fine d< 

membrane, which is called the peri otkum. It appears fibrous, 
and is not sensible to any great degree when free from 
ease. It supports and keeps in pis Is and tu 

which enter the bone, and if an; Table portion of it be 

torn oif, the corresponding pert of the bones is extn 
to die for want of support, particularly if the inj 
place where the bone is thick and hard in structure. V. 
inflamed, t lie periosteum may become the seat of intense pain, 
as those who bave suffered with thf form of felon will 

be willing to acknowh 

In all the moveable joints, we see the extremities of the 
bones which form them covered with cartilage. The I 
structure of the cartilages of the joints is not known: 
seem to be composed of lil 

and they run directly from the extremity of the bone toward 
the cavity of the joint. One of these cartilag end 

of each bone, and when placed together, they form the I 



OUTLINE OF ANATOMY. 35 

or ball and socket, which composes the joint. Their adjoin- 
ing surfaces are among the smoothest in nature, and they are 
covered with an extremely delicate and polished membrane, 
which has been already alluded to when we were speaking of 
the serous cavities. This membrane contains the synovia, or 
oil of the joint. The articular cartilages are totally insensible, 
and their vital and diseased actions are as little known as their 
structure. Not so the synovial membrane, which, when in- 
jured and inflamed, becomes the seat of acute pain and serious 
disease. 

The ligaments are strong, flexible, and generally inelastic 
bands, which bind together the different bones, and prevent 
the joints from exceeding the proper bounds of their motions. 
They are composed of cellular tissue very strongly condensed 
and strengthened by an interstitial deposite of a fibrous ap- 
pearance. They differ very widely among themselves, both 
in form and in the arrangement of their fibres. When in 
health, they possess no very obvious sensibility; but when 
they are inflamed or rudely twisted, great pain results; as is 
seen in sprains of the ankle and other joints. 

In white swellings and some other diseases of the joints, 
the ligaments become affected very seriously, and the princi- 
pal reason why we do not more frequently find them diseased 
is, because they are so sparingly supplied with vessels and 
nerves — those most potent encouragers of vital energy. When 
they do become inflamed, the same sluggishness of the vital 
power renders their recovery slow and difficult; hence, the 
cause of the long continued soreness which folio 
sprains, particularly those of the loins from over lifting. When 
ligaments have once been stretched by any great force, they 
often continue permanently lengthened, and the patient may 
then become incurably lame. We see this result most fre- 
quently, in consequence of sprains of the ankle, and those of 
the internal ligament of the knee joint. 

The parts thus noticed in a cursory manner, namely, the 
bones, the articular cartilages, and the ligaments of the joints, 
compose the skeleton, or frame work of the locomotive appa- 
ratus; they are the levers and pulleys of the human machine, 
and it is proper to take a glance at their general arrangement 
before we pass on to the description of the powers which act 
upon them, and put them in motion. 



36 



OUTLINE OF ANATOMY. 



Fig. 3. 




OUTLINE OF ANATOMY 



37 



OF THE SKELETON. 

The skeleton is usually considered as divided into the bones 
of the heady those of the trunk, and those of the extremities. 
Of these parts, the trunk may be regarded as the basis, for we 
find it present in all animals, though many exist without either 
of the other divisions. The head stands next in importance, 
for it appears in. many animals who are altogether deprived of 
extremities properly so called. 

The bones of the trunk, in the adult man, are fifty-three in 
number. Of these, twenty-four are called vertebrae, and when 
taken collectively, form the spine or back bone. 

The Spine, is a strong bony column extending along the 
back part of the trunk, from the lower part of the loins to the 
head. It is much thicker below, than at the summit, but its 
bulk varies in different places, in a manner not in strict ac- 
cordance with any regular law. If viewed in front or rear, 
the spine appears perfectly straight when at rest; but if exa- 
mined in profile, or laterally, it presents several strong curva- 
tures, — sweeping considerably forward in the middle of the 
neck, and again in the loins, but projecting very much back- 
ward behind the chest. Each of the twenty-four bones which 
contribute to form the spine, except the uppermost, has a 
broad body, of a circular form, (a, fig. 4.) flattened above and 
below, where it approaches its neighbour. On the back part 
of this body we find a bridge of bone which extends from 
one side to the other, enclosing a small ring, (b.) through which 
the spinal marrow passes, and on the back and sides of this 
bridge, are several eminences of bone, (c, d.) mostly designed 
to give a proper attachment to the ligaments and muscles of the 
spine. 

A DORSAL VERTEBRA VIEWED PERPENDICULARLY. 



Fig. 4. 




a, The flat side of the body of the bone* 
where it lies in contact with the next 
bone above. 
h, The ring- or canal, through which the 
spinal marrow passes, surrounded by the 
bridge of bone which spans the back of 
the body of the vertebra, 
c, The spinous process which projects 
obliquely backwards and downwards, 
and forms one of the long line of bony 
knobs, which we feel, when the finger is 
passed down the back. 
a\ d, Transverse processes. 
e, c, Articulatory processes. 



38 OUTLINE OF ANATOMY. 

One of these projections on each side above the bridge, 
and one on each side below, (e, e,) is designed to assist in 
forming the joint between each vertebra and its next neigh- 
bour, and these joints are differently arranged in different 
parts of the spine, so as to allow more motion in one place 
than in another. 

As the head is obliged to move in all directions, a special 
arrangement is made of the joints between the two uppermost 
vertebrae and the cranium or bones of the head, properly so 
called, by which the latter have a pivot-like movement from 
side to side, so that the face may be turned to a considerable 
extent without the aid of the vertebrae of the neck, in general. 

That portion of the spine which is found in the neck is 
likewise capable of considerable motion; for it may be bent 
backward and forward, or to either side, and it may also be 
twisted through a portion of a circle, so as greatly to assist in 
placing the head in any desired position. That portion of the 
column which lies behind the chest is composed of bones so 
closely jointed, and so fixed by their connexion with the ribs, 
and by many projections interlocking with each other, that 
it is almost immoveable; but that part which supports the 
loins, though more fixed than the neck, may bend forward or 
to either side, or it may be rotated to a certain distance — as 
when we attempt to turn the head completely round without 
altering the position of the feet. 

If the flat surfaces of the bodies of the vertebrae were in 
contact, the whole spine would be converted into a solid co- 
lumn of bone, and of course all motion would be rendered im- 
possible. To prevent this difficulty nature has interposed be- 
tween them a thick layer of a substance resembling cartilage, 
which is flexible and in a slight degree compressible. It is 
a very curious fact that the weight of the body during the day, 
while we remain erect, gradually presses these cartilages flat- 
ter; but in the night, while we are in bed, they slowly return 
to their original thickness. Now, as each of the twenty-four 
layers loses and gains its proper width during these diurnal 
changes, the sum of all these little expansions and contractions 
produces very obvious effect, and a tall man is found to mea- 
sure considerably less in height at bed-time than he does in 
the morning. The cartilages just mentioned, give very great 
strength to the spine, while they permit the necessary motions 
of the body, to which each bone contributes its share. This 
is indeed a most wise arrangement; for if any one joint in the 
spine were endowed with the power of sudden or extensive 
motion, the spinal marrow would be liable to continual acci 
dents, and life would be perpetually endangered; for it is a ge- 



OUTLINE OF ANATOMY. 39 

neral principle in mechanics that extensive movements pro- 
duce feebleness and a greater liability to disorder. 

Besides the cartilages just mentioned, there are many strong 
ligaments which surround the spine and add greatly to its 
strength. Among the most important of these, are those which 
extend from one bone to another, around the bridges at the 
back of the bodies of the vertebra, and which complete the 
canal through which passes the spinal marrow. 

But the safety of this most important organ is not confided 
entirely to the bones, cartilages, and ligaments; for the nume- 
rous and powerful muscles of the back are so arranged as to 
give still greater firmness to the column which contains it. 

The individual bones of the spine — of which seven belong to 
the neck, twelve to the back, and five to the loins — are almost 
entirely composed of soft cellular structure with no solid or ivo- 
ry-like tables, so that the jar produced by a blow upon any part 
of them is not readily felt at a distance, as would be the case 
if they were more close in their texture. When we consider 
that, in addition to this, the whole spine and its accessory parts 
taken collectively, form a complete spring curved in different 
directions, and that each of the cartilages, separately consi- 
dered, may be regarded as a springing cushion placed between 
neighbouring bones, we may form some idea of the care with 
which we are guarded against injuries by a beneficent Provi- 
dence. Were it not for this arrangement, a very slight fall 
upon the feet would inevitably bruise or tear the brain or spi- 
nal marrow or produce a fracture of the basis of the skull. 

The principal diseases of the spine are irritations, occasion- 
ing various nervous symptoms; relaxations of the muscles 
and ligaments, giving rise to curable deformity; and ulcera- 
tion or mortification of the vertebrae, called caries, producing 
incurable changes of figure, and often death. These highly 
important affections will be fully noticed in the proper place. 

The Ribs — Of these bones, little need be said, for every 
one is acquainted with their general appearance. They are 
twenty-four in number, twelve on each side. They are each 
attached to the vertebrae behind, in two places; first, by the 
extreme ends, called the heads of the ribs, which form joints 
with the bodies of those bones, and secondly, by little promi- 
nences, somewhat farther forward, which are connected by li- 
gaments with bony projections from the sides of the posterior 
bridges that enclose the spinal marrow. 

The seven uppermost pairs of ribs, thus firmly fixed behind, 
are connected with the breast bone in front, by means of long 
cartilages (so called) very closely resembling the ribs in shape, 
and differing from them only in the deficiency of earthy mat- 
ter: they are in fact proper bones, which do not ossify com- 



40 OUTLINE OF ANATOMY. 

pletely, but remain in a condition very similar to some parts 
of the extremities in very young children. When broken, 
they generally unite by throwing out bony matter, and in old 
age, some of them often become completely ossified. They 
form regular moveable joints with the breast bone. The re- 
maining pairs of ribs are called false ribs, because they are not 
directly connected with the breast bone. The cartilages of 
all but the two last pairs generally run together, or are con- 
nected to each other in a somewhat irregular manner, and are 
finally joined to that of the seventh or last true rib before it 
reaches the sternum. The two last pairs are merely tipped 
with a portion of cartilage which is not connected with any 
other. 

The upper pairs of ribs pass in a direction pretty nearly ho- 
rizontal, but each succeeding couple becomes more and more 
oblique as we descend. They are all bound together by mus- 
cles which pass from the edges of each rib, to the opposite 
margin of its neighbours above and below, so that if one pair 
be raised, the others must .follow its movements. They act 
like a series of hoops of different lengths tied together by 
cords; but as the lower pairs with their cartilages are much 
longer and more oblique, than the upper ones, and as they are 
fastened at nearly equal distances from each other both before 
and behind, it follows that when moved, they must sweep in 
larger circles, and thus the lower part of the chest is dilated 
and contracted to a much greater extent than the upper part 
during the act of breathing. The seven superior pairs of ribs 
embrace the chief part of the heart, lungs, and other impor- 
tant organs, and the five inferior pairs give an attachment to 
the circular edge of a large thin muscle called the diaphragm 
or midriff, which divides the cavity of the belly from that 
of the chest. It will be described more particularly when we 
speak of the function of respiration. 

The use of the ribs is to protect the organs within the chest, 
and to assist in drawing in, and expelling the air in breathing. 
They are composed of loose cellular bone covered by a firm 
but thin external coat of harder matter. Their diseases do 
not differ from those of the bones in general. 

The Breast Bone or Sternum, is formed of three pieces 
joined together by strong ligaments, but in old age they are 
frequently found united into one. For all practical purposes 
in the present treatise, these pieces may be regarded as a sin- 
gle bone somewhat triangular in form, reaching from the throat 
to the pit of the stomach. It is about two or two and a half 
inches wide at the top, and tapers to a blunted point at the 
bottom. Its sides are extremely irregular, being festooned by 
the jutting out of the surfaces with which the cartilages of the 



OUTLINE OF ANATOMY. 41 

ribs are articulated. This bone is of cellular structure, and not 
unfrequently a portion of it near the centre remains unossified 
or cartilaginous, so that a dirk or small sword may penetrate 
it with ease. The lower extremity seldom becomes bony 
during childhood, and it sometimes remains cartilaginous till 
late in life. The soft texture and position of this bone, rest- 
ing as it does on the cartilages of the ribs, as if upon springs, 
enable it to furnish effectual protection to the lungs and heart, 
against the effect of falls and blows. It is very rarely frac- 
tured. The two uppermost angles, receive the inner ends 
of the collar bones which are there furnished with moveable 
joints. 

Abscesses within the chest have been known to make their 
way to the surface through the breast bone, and aneurisms 
have sometimes occasioned the absorption of a part of it as 
they do of the ribs. Its other diseases resemble those of the 
bones in general. 

The Basin or Pelvis is formed in infancy of a considerable 
number of separate bones; but in middle age, these become 
united together so as to reduce the number to four. The first 
of these is a large, light spongy bone of a triangular or pyra- 
midal shape, very broad and thick at its upper part, and ta- 
pering nearly to a point below. It is concave in front, and 
convex behind, and is regarded as a continuation of the spine. 
This bone is called the Sacrum; and is composed, in infancy, 
of five parts, each of which resembles a separate vertebra. 
Attached to the lower end of the sacrum, there is another 
small bone, which is composed of four pieces during child- 
hood, and it may be considered as the rudiment of a tail, much 
as such an acknowledgment may mortify the pride of humanity. 
In the adult male, the two bones just mentioned sometimes 
become united into one, which may give rise to considerable 
inconvenience, as the latter is then subject to the danger of 
fracture, a very serious accident, in this situation. In the fe- 
male, this union rarely occurs till late in life, and may occa- 
sion great difficulty in delivery when the junction takes place 
too early. The lower bone is called the Os Coccygis, and 
has a moveable articulation with the sacrum. 



42 



OUTLINE OF ANATOMY 




Fig. 5. The Pelvis. The remainder of 

the basin is formed 
by the share bones, 
which are so irregu- 
lar in shape, that it 
would be improper 
to attempt to de- 
scribe them in this 
work. A glance at 
the accompanying 
figure will convey a 
better idea of their 
form, than could be 
communicated by 
many pages of de- 
scription. 
In infancy, these bones are each formed of three separate 
parts which grow together before manhood arrives. It may 
be well simply to name them here, without' expecting the 
reader to remember them, because, if he should ever have oc- 
casion to refer to other works of a somewhat less popular 
character, he will often find their names employed as if the 
original divisions still existed. The front part of the share 
bone, which extends downward between the bottom of the 
belly and the groin, is called the Pubis; the lower part, which 
supports the body when we are sitting down, is the Ischium; 
and the lateral broad portion with the wings extended up- 
ward, is the Ilium. 

The upper part of the sacrum projects forwards, and there is 
a strong ridge or contraction, which encircles the middle of 
the share bones, which, together with this projection, forms 
what is called the brim of the pelvis. Above this brim, the 
share bones are extended into two large wings which are 
spread outward and upward to a considerable distance, and 
may be plainly felt by placing the hand above the hip. 
These bony wings form a part of the sides of the belly, and 
give a firm attachment to many of its muscles. 

Below the brim, the sacrum and lower part of the share- 
bones form the greater part of the sides of a large cavity? which, 
when completed by the muscles and other soft parts, that fill 
the intervals between the bones, is called the cavity of the 
pelvis. It contains the bladder and the last intestine, together 
with all the parts peculiar to the female. Just below the 
brim of the pelvis and nearly opposite the middle of the share- 
bone on the outer side, we find a large and deep cup-like ca- 
vity in which is received the head of the thigh bone where 
it forms the hip joint. 



OUTLINE OF ANATOMY. 



43 



Having now described all the bones of the trunk, namely, 
the twenty-four vertebrae, the twenty-four ribs, the breast bone, 
and the four bones of the basin, we here leave the trunk and 
pass on to the next great division of the bod)*, the head. 



THE HEAD. 



The bones of the head are divided into those of the crani- 
um and those of the face; the former enclosing the cavity for 
the reception of the brain, the latter furnishing support to the 
features, and to the organs of three of the senses — sight, smell, 
and taste: those of hearing being located in one of the bones 
of the cranium. 

The cranium is composed of six bones, which are properly 
its own, and there are two others common to it and to the 
face. 

The six bones proper to the cranium are for the most 
part thin, not exceeding one-fourth of an inch in thickness in 
most persons and places, (fig. 7, -,) and in some situations the 
light may be distinctly seen through them, when held opposite, 
to a candle. They surround the whole cavity for the brains ex- 
cept a small portion of the floor of that cavity, immediately over 
the nose and the upper part of the throat, which is formed by 
the two bones common to the cranium and face. The parts of 
the several bones which form the floor of the cavity are ge- 
nerally much thicker than those which form its sides, back, 
and roof; but the partitions between the orbits of the eyes and 
the brain, and those also which cover the nose are extremely 
thin and delicate. F'g- 6 - 

These bones are formed 
within and withoutof very 
firm hard tables, separated 
from each other by a lay- 
er of soft cellular struc- 

ia ""^iryi8 1 tlllc * The inncr ,ab!e re ' 

a rfl ^ww. Wk sembles ivory in close- 

ness, but the outer is more 
like the middle portions 
of the long bones in den- 
sity. In some places, 
these tables arc widely 
parted, and the inter- 
32 vening cellular matter is 

wanting, sothatcavities are formed within the skull, (fig. 7, 7 ,) but 
they are unlike those of the long bones, for they contain nothing 
but air. All these cavities communicate either with the nose 
or throat, and are not developed until the individual approaches 




44 



OUTLINE OF ANATOMY. 



4 



the age of puberty. They are designed, like the barrel of an 
organ, to deepen the tone of the voice. One of the most re- 
markable of these cavities is formed behind the inner end of 
the eyebrow; it is familiar to farmers as the part which lodges 
the worm in sheep; and cases of the same nature have been 
knOwn to occur in man, (fig. 6, 5 , 5 .) When a severe blow 
is received over the eyebrow, it is not unusual to see the 
outer table of the skull broken or crushed into the cavity 
just mentioned, without any injury of the inner table or to 
the brain which it covers. 

The cavity of the cranium resembles an egg in shape, the 
small end presenting toward the forehead, but over the eyes 
and nose there is a considerable variation from this shape, as 
if the egg had been broken and somewhat dented inward at 
that part. Some idea of the dimensions of this cavity may be 
formed by supposing the head to be divided by a plane pass- 
ing from the eyebrows through the tubes of both ears to the 
point of junction between the head and neck behind. All that 
lays above this plane is the cranium proper, and after deduct- 
ing the thickness of the bones and soft parts which cover it 
the remainder is the cavity. It is completely filled with the 
brain. Fig. 7. 

The bones of the cra- 
nium in infancy are re- 
markably thin and deli- 
cate. They are imper- 
fectly ossified, and the 
edges and corners re- 
main for a time in a mu- 
cilaginous state, being 
composed of delicate cel- 
lular tissue well supplied 
■/3with blood vessels, and 
filling up the space be- 
tween the internal and 
external periosteum or 
membrane which covers 
the bones. The parts 
called by mothers the 
openings of the head, where we feel no bone in young chil- 
dren, but where the finger perceives the pulsations of the 
brain through the skin, are in reality portions of the cranium 
in this primitive or soft state. 

This deficient ossification prevents the different bones of the 
child's head from coming into absolute contact, and the thin- 
ness of the edges permits them sometimes actually to slide 
over each other so as to diminish the size and change the shape 
of the head, in very difficult labours, without injury to the 




m 



LONGITUDINAL SECTION OF THE HEAD. 



OUTLINE OF ANATOMY. 45 

brain. This important provision of nature preserves the ex- 
istence of thousands at the very onset of life. 

When young children are attacked by dropsy of the brain, 
these bones, being connected only by soft parts, are stretched 
asunder by the pressure of the fluid within, and in this way 
the head becomes enormously enlarged, yet the patient may 
live; whereas if the same disease should exist to any conside- 
rable extent after the bones become firmly united, death, from 
compression of the brain would inevitably follow. 

Even the ossified parts of the young head, although they 
are never entirely cartilaginous like some other parts of the 
skeleton, do not contain a very large amount of earthy matter. 
They continue to be, in some degree, flexible for a few months 
after birth. This condition of the parts protects the brain 
from being wounded by many of the unavoidable accidents of 
childhood; for these soft bones often yield, where, if they were 
harder, they would break. Even when actually broken, for 
this sometimes happens, the pieces do not form sharp edges 
and points as they do at a later period in life, but they rather 
tear like stiff paper; and even when driven inward, so as to form 
a star-like depression, the fragments generally preserve some 
connexion with the rest of the bone: in such cases the brain 
is pushed before the depressed portions, but the other bones 
and the softer parts of the head make room for it by allowing 
themselves to be swelled outward. After a time the pulsa- 
tions of the brain often succeed in pushing the pieces into their 
proper place, and little trace of the injury remains. I have 
seen a case of fractured skull in delivery produced by a de- 
formity in the mother, and several others in children under 
the age of one year, in which scarcely any unpleasant conse- 
quences followed. 

As the child grows older the bones of the head grow thick- 
er and stronger until they enclose the whole cavity of the cra- 
nium, being dove-tailed into each other along all their edges 
in a manner which renders their joinings as strong as their other 
parts. This kind of articulation is called a suture, (fig. 7, 6 , 6 ,) 
and a single glance at a skull will enable the reader to perceive 
how beautifully it is adopted to produce uncommon strength. 

The cranium, when fully formed, is a long case, arched and 
rounded in every direction, so as to oppose the greatest possible 
resistance to blows and other injuries, with the least possible 
expense of material. In those piaces where it is most exposed 
to accident, as at the back, and the most prominent parts of the 
sides of the head and forehead, it is thicker, and there is more 
of the cellular structure interposed between its tables, (fig. 7, 2 .) 
On the contrary, where the surface retreats a little, or where 
it is protected by thick muscles, as on the temples, it is very 



46 OUTLINE OF ANATOMY. 

thin, and the two tables are almost in contact. Directly over the 
eye there is a smooth plate of bone which eovers the orbit and 
forms part of the floor of the cranium on which the brain re- 
poses. This plate is as thin as writing paper, and so weak 
that a thrust with a small sword in the eye is considered in- 
evitably fatal, as the weapon penetrates it and enters the brain 
with the utmost facility. There is a still more delicate divi- 
sion between the upper part of the nose and the brain, and the 
bone is in this place rendered additionally weak by the great 
number of little holes which pass through it to give passage 
to the branches of the nerves of smell. The back part of the 
external bones of the nose lie in contact with this very tender 
plate, and hence a hard blow on N the root of the nose has been 
known to produce death by causing a fracture there, and a 
consequent injury to the brain; an accident which would be 
much more frequent were it not for the protection given to 
the part by the solid overhanging ridge of the eyebrows. The 
internal organ of hearing, on the contrary, is enclosed in a 
portion of bone extremely hard and thick, which forms the 
middle of the floor of the cranium, and the greater part of this 
floor is formed of portions of bone of a very irregular shape 
and thickness, of a more cellular texture, and penetrated with 
numerous holes for the passage of many nerves, the exit of the 
veins, and the entrance of the arteries of the head. A little 
behind the middle of the floor, we find a very large round hole, 
about an inch in diameter, (fig. 7, 13 ,) through which the spinal 
marrow passes from the vertebral canal, already described, into 
the head, to be connected with the brain. At the sides of this 
hole we find the two articular prominences by which the head 
is supported on the first bone of the spine. 

Before leaving the head it will be proper to mention the 
name and position of the six bones proper to the cranium, as 
they are frequently met with in popular works. 

The first or frontal bone, (fig. 6, l , and 7, 3 ,) forms the whole 
forehead, and extends an inch or two above the commencement 
of the hair. It also furnishes the two thin plates which extend 
backwards from the brow and cover the orbit of the eye. 

The two parietal bones (fig. 6, 2 , and 7, ',) are nearly rectan- 
gular, and extend on each side of the middle line of the head, 
from the back part of the frontal bone to the vertex or crown of 
the head, and from the middle line just mentioned to about the 
top of the ear. The centres of these bones are clearly marked 
by the strong swelling or protuberance usually observed at 
the back part of the side of the head. 

The two te??ipor a I bones (fig. G, 4 .)are found, one on each side of 
the head, at its lower part. They have each a broad, thin, wing- 
like expansion which forms the greater part of the temple, and 



OUTLINE OF ANATOMY. 47 

a long, narrow process which is so joined to the cheek-bone as 
to form a bridge, elevated three-fourths of an inch above the 
general surface of the skull, which covers and keeps in place 
one of the principal muscles designed to close the lower upon 
the upper jaw, (fig. 6, 8 .) They also contain the external open- 
ing of the ears, and provide that solid mass of bone which forms 
the middle portion of the floor of the cranium, and encloses 
the internal parts of the ear. Those pap-like eminences (fig. 7, 
17 ,) which we feel immediately behind the ears are portions of 
these bones; they are hollow within, and its cavity communicates 
with the cavity of the drum of the ear, and also with the throat 
by means of long fleshy tubes, which are sometimes closed by 
inflammation, producing a species of deafness. 

The occipital bone, or occiput, forms the back part of the 
head behind the crown, and a very considerable part of the 
floor of the cranium, (fig. 6, 3 , and 7, 5 .) It is in this bone that 
we find the large hole for the passage of the spinal marrow, and 
the joints which connect the head with the spine. This portion 
of the occiput is thicker, softer, and more spongy, to assist in 
protecting the brain from the jar which follows a fall from a 
height upon the feet. The whole mechanism of the cranium 
displays a wonderful combination of strength and lightness, 
and is admirably adapted for the preservation of the all-impor- 
tant organs which it encloses. 

Of the two bones common to the head and face I need not 
speak, as in this very hasty anatomical sketch I propose to 
dwell only upon such points as are useful to the general read- 
er, avoiding whatever is only intelligible to adepts in medi- 
cine. They form the middle and part of the front portion of 
the floor of the cranium. 

The face is composed of thirteen different bones, but it is 
altogether foreign to our purpose to describe them here. A 
few remarks on some of those bones will be found in the arti- 
cles on the diseases and accidents to which they are liable. 



THE EXTREMITIES. 

The superior extremities are each composed of thirty-one 
bones, the two first of which are the collar bone and shoulder 
blade. 

The collar bone is long and slender, but it is made of very 
firm materials, and is almost completely ossified at birth. It 
is about as thick as the fore finger, and somewhat resembles 
the letter S in form. It is connected by regular moveable 
joints, with the breast-bone at its inner extremity, and with 
the shoulder blade at its outer end. It may be plainly felt 



48 OUTLINE OF ANATOMY. 

throughout its whole length, as it forms a salient ridge be- 
tween the bottom of the neck and the top of the chest. Its 
principal uses are to keep the shoulder joint at a sufficient dis- 
tance from the side of the body to facilitate the motions of the 
arm, and to protect the nerves and blood vessels on the front 
of the neck from blows and other accidents. 

The shoulder blade is a broad, flat, thin bone, of a triangu- 
lar shape, which covers a considerable part of the back and 
side of the chest. Its hinder edge is easily felt, extending near 
the spine, from the bottom of the neck to near the middle of 
the back; its upper edge, which is deeply buried, runs in a 
horizontal direction along the bottom of the neck to the shoul- 
der joint; and its third edge passes obliquely from this joint 
to the lowest point of the first. 

Along the back of this bone, not far below the top, the fin- 
ger perceives a long and very strong ridge which runs from the 
hinder edge forward, and a little upward to the shoulder joint. 
This ridge or spine becomes very wide and strong at its outer 
extremity, where it hangs over the joint and forms the point 
of the shoulder. At a short distance below this point we find 
the outer corner of the shoulder blade, and upon it the shal- 
low cup-like cavity that receives the round head of the bone 
of the arm, with which bone it forms the shoulder joint. The 
only firm connexion between the bones of the superior extre- 
mities and those of the trunk is through the medium of the 
collar bone, upon which the shoulder blade appears suspend- 
ed, if we may be allowed the expression, by the extremity of 
its spine. 

The shoulder blade is every where surrounded, lapped up, 
and supported by numerous very large muscles, coming from 
the head, the spine, the ribs, the sternum, or from its own 
edges and spine; and these muscles have the power of pulling 
it in every direction, so as to produce the various motions of 
which the shoulder joint is capable while the arm hangs inac- 
tive. 

Our remarks upon the bones of the extremities must be ne- 
cessarily very brief, and I shall therefore confine my attention 
to a few points of paramount importance, as all details on this 
subject are connected rather with the practice of surgery than 
with that of medicine, and are therefore less interesting to the 
class of readers for whom this work is designed. 

The bone of the arm extends from the shoulder joint to 
that of the elbow. Its shaft or body is nearly cylindrical, but 
it becomes considerably larger at its upper extremity where 
we find a hemispherical eminence on the side next the body, 
which is covered with an extremely smooth cartilage. The 
face of this eminence looks inward and upward; it is received 



OUTLINE OF ANATOMY. 49 

into the shallow cup. already described as terminating the 
outer angle of the shoulder blade: thus a regular bail and 
socket articulation is formed, which permits the arm to be 
moved to a great extent and in every direction. 

From the shallowness of this joint, the shoulder is very lia- 
ble to be dislocated, but the projection of the ridge or spine of 
the shoulder blade prevents the head of the bone from being 
pressed upward, and it is almost always displaced in the down- 
ward direction. 

The lower end of the hone of the arm is very much wi- 
dened laterally, and flattened before and behind. It termi- 
nates in a rounded scroll or cylinder that looks as if it were a 
separate piece set crosswise upon the bone. The surface of 
this scroll is coated with smooth cartilages, and is divided by 
an elevated ridge which passes round it, causing it to resemble 
the surface of two pulleys united together. Upon the cartilage 
covering this scroll the two bones of the forearm work, and 
the elbow joint thus formed has a perfectly hinge-like character, 
its only motions being forward and backward. 

The Ulna is the bone of the forearm chiefly concerned in 
forming the elbow joint. It grasps the scroll-like extremity 
of the bone of the arm, much in the manner that the hand 
grasps a large roll of paper, the p;irt corresponding with the 
palm and fingers being on the hinder side. The ulna does not 
stop exactly at the joint, but projects a little above it behind, 
so that when the forearm is fully extended this projection 
comes in contact with the bone of the arm and prevents the 
former from bending farther back; it has also a slight eleva- 
tion on the front side of the ulna, which is partly intended to 
check in the same manner the too great flexion of the fore- 
arm. 

The ulna gradually tapers from the elbow to the wrist, 
where it becomes very slender, and is coated with cartilage 
so as to form a very small part of the wrist joint. It lies along 
the inside of the forearm, and terminates at the side of the 
wrist next the little finger. Its broad connexion with the el- 
bow joint keeps it so fixed that it cannot turn, and it has only 
a hinge-like motion at that joint. 

The Radius is the second bone of the forearm, and is chief- 
ly concerned in forming the wrist joint. Its upper extremity 
is very slender, and is capped by a tolerably thick ring or 
wheel of bone much wider than the body of the radius at this 
place. The upper side of the ring is a little hollowed, and fits 
on to the outer part of the scroll-like extremity of the bone 
of the arm in such a manner that it enjoys not only the hinge- 
like motion in common with the ulna, but also a rotatory mo- 
tion on its own axis. Not only the upper surface but the edge 

7 



50 OUTLINE OF ANATOMY. 

also of this ring is covered with cartilage, and the edge is re- 
ceived into a smooth notch in the side of the ulna, against 
which it is confined by ligaments, forming a joint which does 
not interfere with its rotatory movements. 

At its lower extremity the radius becomes very much en- 
larged, more especially in breadth, and terminates in a wide 
and slightly concave surface coated with cartilage, which, with 
some little assistance from the ulna, forms the upper surface 
of the wrist joint. On the inner side of this lower extremity 
of the radius there is a semi-lunar notch which plays over the 
side of the small rounded end of the ulna, both these parts be- 
ing covered with cartilage and secured by ligaments. This 
arrangement, together with that of the joint already described 
between the upper ends of the same bones, permits the radius 
to revolve round the lower part of the ulna, carrying the hand 
with it, so as to present the palm upward or downward at 
will. 

The Wrist is composed of eight bones, connected together 
by joints so various and complex as almost to- baflfle descrip- 
tion. They occupy the space between what is called the wrist 
joint and the line at which the wristband of a well made shirt 
terminates upon the hand. Their movements upon each, 
though slight and almost imperceptible, are all-important in 
character, and contribute in a great degree to the perfection of 
that instrument to the possession of which philosophers attri- 
bute much of the superiority of man over the inferior creation, 
the master-piece of animal mechanics, the human hand! It 
would be altogether in vain here to attempt an explanation of 
movements which even professed anatomists who comprehend 
them, would find it impossible to describe. 

Taken collectively, and considered as if they were but one, 
the bones of the wrist form a rounded somewhat circular sweep 
at their upper edge which is covered with cartilage, and fits 
into the cavity formed by the lower extremities of the two 
bones of the forearm. The joint thus formed permits the hand 
to be bent to a considerable extent backwards, forwards, and 
inward or toward the little finger, but only very slightly out- 
ward or toward the thumb. The lower edge of the bones of 
the wrist is very irregular to accommodate the articulations of 
the five long slender bones which support the fingers and 
thumb, and which are plainly felt in the substance of the hand. 
The wrist is strongly arched on the back, and still more 
strongly concave toward the palm, which circumstances ren- 
der it admirably adapted for grasping and holding rounded 
bodies. 

The long bones that support ihejingers and thumb enjoy 
no great extent of motion; but that which they do possess is 



OUTLINE OF ANATOMY. 51 

of incalculable value. Those of the fore and middle fin- 
ger are nearly fixed, but that of the thumb enables us to op- 
pose it to the palm, — a power of such importance that a stiff- 
ness of the upper joint of this bone destroys perhaps four-fifths 
of the usefulness of the hand, and as the bones corresponding 
to the ring, and more especially the little finger, contribute 
greatly to this opposition, the loss of their motions should be 
considered a much more serious disaster than the entire de- 
struction of the middle finger, with its supporter. 

The bones proper to the fingers and thumb, being four- 
teen in number, are so completely subject to observation that 
it is unnecessary to speak of their form and motions. There 
are a few other small bones varying in number in different 
individuals, which are commonly ranked among the bones of 
the hand, but they are rather appendages to the muscular sys- 
tem than to the skeleton, and we shall not notice them. 

The Inferior Extremities are formed on the same general 
model with the Superior, and it will be sufficient for our pur- 
pose to notice the principal points of difference without repeat- 
ing the description of each particular bone. 

The Hip Joint. There is nothing corresponding to the col- 
lar bone or shoulder blade in the inferior extremities. 

The very deep cup-like cavity for the hip joint, situated 
near the middle of each of the share-bones, has been already 
mentioned. Now the head of the thigh-bone which fills that 
cavity forms a much larger portion of a sphere than the cor- 
responding part of the bone of the arm, and it is much more 
deeply and firmly embraced in the joint, like the ball in the 
socket attached to a surveyor's compass; its motions are there- 
fore much more limited; it is more difficult to dislocate it, and 
also to replace it when once thrown out. It is secured not only 
by a strong capsular ligament, but is likewise furnished with 
a very powerful cord-like ligament passing from the middle of 
the ball to the bottom of the socket; the latter must be broken 
or detached, and the former is almost always torn before it 
can be put out of place. 

The head of the thigh-bone is not situated directly on the 
shaft as is that of the bone of the arm, but stands on the end 
of a neck of considerable length, running from the side of the 
shaft upward and inward to the joint. In old age this neck 
becomes shorter and softer, and bends downward till at length 
it stands nearly at right angles to the shaft of the bone; hence 
it is very seldom broken in persons under fifty years of age, 
but much more frequently in very old people. This change 
is one of the causes of the diminution of stature in advanced 
life. 

The Knee Joint differs from the elbow in being formed by 



52 OUTLINE OF ANATOMY. 

two long bones instead of three. The scroll at the lower ex- 
tremity of the thigh-bone is indented round the middle by a 
very deep groove, and seems almost divided into two heads. 
Each of these apparent heads rests on a shallow depression 
upon the upper flat surface of the tibia — the bone which forms 
the shin. This latter is very large and stout; it is swelled 
out at its upper end until it becomes as wide as the whole knee 
joint, and thus gives ample support to the body. It has no 
bony projections, like those of the ulna, to check the too threat 
flexion or extension of the leg, and this deficiency is chiefly 
remedied by two strong ligaments crossing each other within 
the joint, one or other of which is put upon the stretch when 
the leg is straightened or bent to its utmost extent. 

Besides these and the capsular ligament, the knee has very 
strong lateral ligaments — particularly on the inside — for the 
obliquity of the thigh and the straightness of the leg produce 
a strong tendency in the knee to bend inward under the weight 
of the body. In heavy lifting, or in violent jumping, the in- 
ner lateral ligament is sometimes stretched orelongated, and 
almost incurable lameness results. 

There is yet another small round bone connected with the 
knee joint, which has no parallel in the superior extremity. 
This is the Patella, or cap of the knee. It is enveloped in 
the tendon of the muscles that extend the leu;. This tendon 
passes over, and around it, to be attached to the shin bom . 
below the joint. The patella is smooth and covered with car- 
tilage on its inside, where it is fitted to the groove or pulley 
of the thigh bone, over which it plays. It protects tiie front 
of the joint, and acting like a pulley, enables the muscles con- 
nected with it to act at a considerable mechanical advantage. 
It may be dislocated in dancing or leaping, but may be gene- 
rally pushed hack without much difficulty. It is sometimes 
broken by similar exertions, or by blows, a most unfortunate 
accident, for the muscles immediately draw the upper frag- 
ment away from the lower one; they can then be kept in con- 
tact only by extreme care ami skill, and unsuccessful treat- 
ment is followed by incurable lameness. In this particular, 
the patella resembles the projection of the ulna behind the el- 
bow, which is liable to similar disasters. 

The Tibia, or Shin Bone, is very thick, and shaped like a 
triangular prism. Its upper and larger end forms all the lower 
surface of the knee joint and its lower extremity forms nearly 
the whole of the ankle joint. It has no rotatory motion. 

The Fibula or lesser bone of the leg, is also somewhat tri- 
angular, but it is very slender and delicate. It is articulated 
above with the outside of the bulging extremity of the last 
bone, and below with the side of its lower extremity, by two 



OUTLINE OF ANATOMY. 53 

small, nearly flat surfaces. It projects somewhat beyond the 
lower end of the tibia, and one side of the projection contri- 
butes to the ankle joint, while the other forms what is com- 
monly called the outer ankle. It has almost no power of motion. 

The Ankle Joint. That bone of the instep which is inte- 
rested in the joint has, on its upper surface, an eminence like 
the half of a solid cylinder set crosswise with regard to the 
foot, and this is received into a corresponding depression in 
the bottom of the tibia — thus forming a hinge-like articulation. 
To strengthen this hinge, the inner part of the tibia sends 
down a process which faces the corresponding end of the cy- 
linder, and forms the inner ankle, while the fibula, extended 
as already described, faces the outer end, and forms the outer 
ankle. The process of the articular bone of the instep, just 
mentioned, does not entirely fill the cavity thus formed by the 
two bones of the leg, so that the foot not only enjoys the plain 
hinge-like motion, but it may also perform some little rotation, 
and the sole may be turned considerably inward, or somewhat 
outward. The former of these motions is increased by a very 
slight mobility of the fibula, and the latter, by a more complex 
change of position among the several bones of the instep. To 
facilitate these various actions, the ligaments of the ankle joint 
are longer or more relaxed than most others; the stability of 
our footing depends mainly on the balance of power among 
the various muscles of the leg, and calls for the co-operation 
of consciousness and the will; hence, sprains of the ankle oc- 
cur very frequently to heedless walkers. By long practice, 
the ligaments of the ankle joint may be stretched so as lo al- 
low the foot to assume attitudes altogether unnatural, and it is 
consequently rendered much more liable to injury. The vo- 
taries of Terpsicore are not aware that they owe much of their 
pretended grace to an absolute deformity. 

The bones of the Instep, are seven in number, they form, 
together with the long bones supporting the toes, a very strong 
arch admirably adapted to sustain the weight of the body, 
which rests chiefly on the heel and the ball of the great toe. 
In raising the body on the toes, very great force is required, 
and in order that the muscles which effect this motion, may 
act at a considerable mechanical advantage, the bone of the 
heel is lengthened out, to some distance beyond the ankle 
joint, and the tendon of those muscles is inserted into its very 
extremity. 

The toes possess no power of antagonizing each other like 
the thumb, fingers and palm — hence, their uses and applica- 
tions are few and simple, but like the different parts of the 
hand, they vary greatly in importance. The ball of the great 
toe, as it supports a large share of the weight of the body, 



54 OUTLINE OF ANATOMY. 

stands decidedly at the head of the list: when the toes are ex- 
tensively crushed, so long as this part is preserved, the injury 
is considered comparatively slight. 

I have now noticed all the parts proper to the skeleton, but 
there remains one very curious bone, shaped somewhat like a 
new moon; it is small and delicate, and is composed of a body, 
two short, and two long horns, the last being generally at- 
tached to the first by small portions of bone in the cartila- 
ginous state, which permit some degree of motion. This bone 
is found at the root of the tongue, following the motions of 
that organ, and it hangs chiefly suspended on certain muscles 
of the tongue, the lower jaw, and throat It is only connected 
with the skeleton by means of a few long and very slender 
ligaments. 

There are also four minute bones connected each with the 
ear, but these will be noticed when we consider the sense of 
hearing. 

The reader has now before him, such a general view of the 
structure and mechanical arrangement of the tiealthy skeleton 
as our narrow limits will allow. I will, therefore, close this 
review of the osseous system with a few remarks upon the 
changes produced in it by age and disease. 

In old age the cartilaginous layers between the different 
bones of the spine become thicker and harder, so that the 
length of the column is considerably diminished, and as this 
change takes place more rapidly before than behind, the bodies 
of the vertebrae tilt forward, and produce the characteristic 
stoop and the rounded back of age. Both these causes tend 
not only to lessen the stature of the individual, but likewise to 
limit the extent and facility of motion in the back. 

The ribs are for the same reason approximated toward each 
other, and some of their cartilages become partly or entirely 
ossified. This prevents them from moving with their original 
freedom, and necessarily embarrasses the function of respiration, 
thus assisting in rendering the action of the heart and arteries 
slow and sluggish in a manner that will be more particularly 
noticed hereafter. 

The harder parts of all the bones become still more firm 
with age, in consequence of the continual deposition of earthy 
matter within their substance, by which their cells are filled 
up, and the quantity of their cartilaginous and cellular struc- 
ture is proportionably diminished. The number of their 
blood vessels is lessened, and they sometimes become brittle 
for want of sufficient animal matter to glue the earthy parti- 
cles firmly together. The softer parts, on the contrary, such 
as the ends of the long, and the bodies of the short bones, with 
the cellular structure between the two tables of the skull, he- 



OUTLINE OF ANATOMY. 55 

come still softer with age, and yield more or less to the ef- 
fect of continued pressure, so as to contribute in no small de- 
gree to the diminution in stature. These changes will at once 
explain the frequent occurrence and difficult cure of fracture 
in advanced life. 

The diseases of the osseous system may affect the whole 
skeleton, or only certain particular bones or their several parts. 

The most remarkable of those of the former class are, first, 
the brittleness of bone, (fragilitas ossium,) which arises from 
a deficiency of the animal or cartilaginous matter, and occa- 
sions fractures from the slightest cause, such as throwing a 
stone, stepping from a high side walk, &c; secondly, softness 
of bone, (mollities osseum) caused by an absorption of the 
earthy matter, even of the most solid parts, permitting the 
bones to bend and twist by the action of the muscles, until in 
some cases, the miserable sufferer loses almost all resemblance 
to humanity. Thirdly, the rickets — a disease somewhat re- 
sembling the last, but occurring chiefly in children, from a de- 
ficient secretion of earthy matter. The two first mentioned 
diseases are almost unknown in this country; the last is also 
rare, but it will be noticed in the proper place. 

There are many diseases generally called constitutional, 
which may affect the osseous system to a greater or less ex- 
tent, without involving the whole skeleton like those men- 
tioned above. Thus scrofula not only produces those affec- 
tions of the joints, cartilages and ligaments, which are com- 
monly confused under the general head of white swellings, 
but it sometimes attacks even the shafts of the long bones, 
causing them to become swelled, softened, suid converted into 
a mass of loose bony net work, filled with a matter like dis- 
eased marrow. It seems as if the cartilaginous portion was 
diminished, its place being supplied by a glutinous and an oily 
matter, and the cells of the bone dilated to a great extent. 
As the patient recovers, the bone returns nearly to its original 
state. True cancer when it exists for a long time in the im- 
mediate neighbourhood of a bone, causes various changes in 
its structure; its looser parts are softened, and in the long 
bones, the medullary cavity is enlarged without any change 
in the external shape of the bone, whilst the hard crust be- 
comes so thin as sometimes to break with the mere effort to 
turn in bed, and the periosteum peals off with the greatest fa- 
cility, in consequence of the obliteration of its blood vessels. 
Soft cancer, [fungus haematodes,) on the contrary, converts 
the substance of bone into its own peculiar structure, with a 
rapidity truly astonishing — paying no respect to its firmest 
parts, but involving every thing which it touches in one com- 
mon tumour. The venereal disease does not very commonly 



56 OUTLINE OF ANATOMY. 

affect the bone itself, except in a secondary manner by in- 
juring the periosteum from which it derives its support. Its 
most common effect upon this membrane is the production of 
tumours called nodes, which are found in all conditions from 
a simple swelling to a regular ossification of the membrane. 
The irritation thus commenced in the periosteum may be con- 
tinued to the solid substance of the bone, so as to produce all 
the various phenomena of inflammation of that tissue — or it 
may so embarrass the circulation in the blood vessels of the 
membrane, as to cause the death of that part of the bone lying 
immediately beneath it. 

As most of the diseases just mentioned are very rare, some 
of them absolutely incurable, and the remainder very difficult 
to treat, they do not fall within the intention of this work, and 
are merely noticed here in order to give the reader an idea of 
the highly vital character of parts commonly considered as 
mere inanimate levers formed of earthy matter and produced 
and repaired by the surrounding parts. 

The more strictly local d f bone result from irrita- 

tions or inflammations within the;, ind the most 

important of them will be noticed hereafter, when the reader 
is better prepared to comprehend their nature. 



OF Till; .Ml 

The muscles are the organs by means of which arc accom- 
plished all the various perceptible motions going; on in the 
living body, whether they arc performed voluntarily like those 
of the feet in walking, or involuntarily, like those of the bow- 
els in digestion. 

When one of the more perfect animals, such as an ox, a 
sheep, or a fowl is killed and divided, we find the great 
of the bodv. with the exception of the brain, bowels, bones, 
and skin, chiefly composed of two kinds of matter. The 
is white or colourless, containing here and there masses of tat, 
and covers ami tills up most of the cavities or interval- 
the other parts, giving a roundness and finish to the form. 
This is the cellular tissue already described. The other kind 
of matter is red, apparently fibrous, and much less yielding. 
This is commonly called the flesh. It is entirely com; 
of muscles — so that the terms Jlesh. in general lang 
muscle, in works on anatomy, are nearly synonymous. 

If we pass our knife through a joint of meat in certain di- 
rections, we find that we produce a very rough and irregular 
surface, even when we follow the direction of the groin; but 
the practised carver, in carving a pig, or poultry, soon learns 



OUTLINE OF ANATOMY. 57 

to cut in such a manner as to leave the surface of the different 
pieces smooth and regular. This is accomplished by follow- 
ing the course of the natural boundaries between the different 
muscles so as to divide nothing but the intervening layers of 
cellular tissue, without disturbing the muscular fibres. Now a 
little care in discovering and pursuing these boundaries will 
convince the curious that what we generally take for a uniform 
mass of flesh is really a collection of many different muscles, 
some large and some small, each lapped up in a separate sheath 
or fascia of cellular membrane, connected at both extremities 
with the parts that it is destined to move, and never attached 
to the neighbouring muscles except when two or more of 
these organs are designed to contribute conjointly to some sin- 
gle operation. 

Each separate muscle is enclosed in a distinct sheath, as I 
have just mentioned, and the strength and thickness of the 
envelope varies with the size and position of the enclosed or- 
gan; its use is to bind down the whole muscle and keep it se- 
curely in its proper relative position. In some situations a 
number of muscles together enjoy additional security against 
misplacement, by being collectively covered by a still stronger 
and broader fascia, protecting both them and their sheaths. 
The thigh and the forearm furnish instances of this arrange 
ment. 

Upon cutting into a muscle thus enclosed, we find it appa- 
rently composed of a number of large fibres, or bundles of 
fibres, tied together by a portion of cellular substance more 
delicate than that which composes the sheath. By careful dis- 
section we find each of these fibres composed of many others, 
still smaller and united by membrane still more delicate. In 
this way we may go on dividing, through several series of 
compound threads, until we reach the most slender, which is 
incapable of farther separation, and is called the ultimate or 
elementary muscular fibre. 

Fig. 8. The elementary muscular fibre is ascertained 

by the best microscopic observations to be formed 
of a great number of little round globules like 
those found in the blood, ranged in a straight 
row, and connected by a very transparent jelly- 
like matter which enters between them, (see. fig. 
8.) As to the nature of this matter, anatomists 
disagree, but it resembles the cellular tissue, and 
no facts are urged to show that it is not of the 
same nature. 

The direction of the fibres is very various in 
the different muscles. In some they run the 
whole length of the organ, side by side; in 
S 




58 OUTLINE OF ANATOMY. 

others they are arranged like the plume of a pen, and are in- 
serted into a hard white membrane which divides the muscle 
lengthwise, &c, but it is unnecessary to dwell upon these pe- 
culiarities in this hasty sketch of anatomy. 

The motions of the muscles are dependent upon certain 
nerves which will be described hereafter; one or more nerves 
being distributed to every muscle, and some of their ramifica- 
tions being supposed to communicate with each particular fibre. 
If one of these nerves be divided, the parts to which it is ap- 
propriated become completely palsied. 

When in health, the muscles are always in a state of ten- 
sion, so that when they are cut across, the surfaces of the inci- 
sion are dragged slowly and widely asunder by the retraction 
of the fibres. This tonic contractile power, as it has been 
called, is of the highest importance; it assists in strengthening 
the joints by holding the contiguous bones firmly in contact, 
for in the articulations capable of extensive and various mo- 
tions, the ligaments are necessarily so relaxed in order to give 
freedom to those motions that they are not in themselves a 
sufficient protection to the joint. This fact is beautifully ex- 
emplified by the effect of a severe blow upon the great muscle 
or mass of flesh which covers the upper part of the shoulder. 
By such an injury the muscle sometimes becomes palsied; it 
loses its tone and wastes away; the mere weight of the arm then 
draws the head of the bone away from the joint to the extent 
of one or more inches. When a bone is dislocated, the neigh- 
bouring muscles are sometimes violently elongated and at 
others they are relaxed, according to the increased or dimi- 
nished length of the limb resulting from the accident, and in 
either case they adapt themselves to their new position in the 
course of a few weeks, so as to give the greatest possible com- 
mand of the member of which the circumstances of the case 
admit. When an old dislocation attended with elongation of 
the limb is reduced, some time is required for the muscles to 
resume their original tension, and the bones are liable to lose 
their proper position again for want of support; but when the 
member is shortened, the contracted muscles offer a tremen- 
dous opposition to the reduction, which, when once effectually 
accomplished, generally remains secure. 

Both the tonic contraction, and the motions of the muscles 
are, more or less, dependent for their strength and pi 
nence, on the nerves — but these organs are much more im- 
mediately connected with the latter than with the former 
function, for when the nerve of a muscle is divided, the com- 
mand of the parts to which it is distributed is almost immedi- 
ately lost, but its tone declines very gradually and seldom dis- 
appears completely. 



OUTLINE OF ANATOMY. 59 

There appears to be a strong vital attraction between the 
particles which compose the muscular fibre; for, during life, 
the muscles will raise with ease a weight that would tear them 
to pieces if applied after death! 

The motions of the muscles are accomplished by the con- 
traction of all their fibres, which draws the parts into which 
their ends are inserted nearer together. This motion is in 
some muscles entirely dependent upon the will during health; 
in others it is entirely independent, and in others it may be 
controlled by the resolution of the individual for a certain 
time, but at length he is compelled to yield to necessity, or 
the motion takes place in spite of his opposition. Hence the 
muscles are divided into the voluntary, the involuntary, and 
the mixed. The first class includes all those which belong to 
the extremities and spine; the second, embraces those which 
enclose the bowels and great blood vessels, giving them their 
peculiar motions, while the third is composed chiefly of those 
muscles which contribute directly or indirectly to the act of 
breathing. Each of these classes of muscles owe their pecu- 
liar powers to the difference between the several systems of 
nerves which supply them; but as these systems are all con- 
nected together so as to influence each other mutually, we 
sometimes find, in disease and in moments of violent emotion, 
the muscles of one class taking on the characters of another; 
thus in all violent passions those of the face, which are ordina- 
rily voluntary, become completely involuntary. In cholera, all 
the muscles of locomotion are sometimes affected in a similar 
manner, and in sudden terror, or in catalepsy, the will is ab- 
solutely annihilated. These causes which thus revolutionize 
the powers of whole systems of muscles are, when acting very 
severely, productive of instantaneous death. This subject, 
however, is only intelligible to those who have some know- 
ledge of the nature of the nerves, and we shall not dilate upon 
it here. 

The Involuntary Muscles are generally hollow, and are de- 
signed to effect the expulsion of the contents of the bowels or 
other cavities which they envelop; their fibres are generally 
short, pale, and very irregular. Their action is such as to 
compress the cavity which they surround and render it small- 
er. They have less tone than the voluntary and mixed mus- 
cles, and yield readily to any distending force that acts slow- 
ly, recovering their original length very soon after its remo- 
val; but they often oppose, most powerfully, the attempt to 
distend them suddenly. One or more layers of this kind of 
muscle envelops each of the principal organs of circulation and 
digestion. The heart is almost entirely composed of a vast 
number of fibres of this class, but redder and more like to 



60 OUTLINE OF ANATOMY. 

flesh than most others; the structure and arrangement of these 
will be noticed hereafter. The stomach is furnished with va- 
rious layers of a similar nature, but quite pale or yellowish; 
the fibres run in many directions, interlacing and overlapping 
each other in various ways. These layers form what is called 
the middle or muscular coat of the stomach, because it lies out- 
side of the rough internal or mucous coat that extends through- 
out the intestines, and within the very smooth serous mem- 
brane that covers the bowels externally. 

The gullet or oesophagus, and the whole length of the intes- 
tines below the stomach, are provided with a similar muscu- 
lar coat, but here the fibres generally run in a circular direc- 
tion around the gut. Some parts of the passage, however, 
have an additional layer of fibres running lengthwise over the 
former, and acting in such a manner as to shorten the bowel 
at these spots when such a change is required. 

When the intestines are full, these fibres are all stretched 
to the uttermost, and the mucous coat is comparatively smooth 
in consequence of the distension; but when Ihey are empty 
the fibres contract until they nearly obliterate the cavity, and 
the mucous coat is thrown into wrinkles, or doubled upon it- 
self. 

When the tone of any of the hollow muscles is lost, either 
by frequent and undue distention, or by any injury to their 
nerves, the action of the corresponding organ becomes feeble, 
its functions are not properly performed, and the contents be- 
ing retained too long, often become a source of irritation and 
actual disease. Many cases of dyspepsia originate in such an 
affection of the stomach, and costiveness of the bowels, fol- 
lowed sometimes by diarrhoea or purging, frequently results 
from the same cause. 

In the bladder, when any great obstacle opposes the 
of urine, it sometimes happens that the fibres are stretched to 
such an extent as to destroy their tone entirely, and the c 
would inevitably burst if surgical means were not emp! 
for the relief of the patient Even after the urine has been 
artificially evacuated in such cases, the organ regains its pow- 
ers very slowly, and the efforts of nature cannot be depended 
upon until it has recovered entirely. 

The most important hollow muscles are the heart, those of 
the muscular coats of the stomach and bowels, and those of 
the bladder, the womb, and the organs of generation; each of 
these different classes of hollow organs will contract and ex- 
pel its contents when distended to I certain degree, or when 
the mucous coat is acted upon by certain irritating substances. 
but it is remarkable that causes which produce strong contrac- 
tion in certain fibres have no effect upon certain others. Thus 



OUTLINE OF ANATOMY. 01 

Ipecacuanha causes the fibres of the lower part of the stomach 
to contract and close the cavity, while it relaxes those of the 
upper part, to allow the contents of the organ to be ejected by 
vomiting. Gamboge, on the contrary, produces an opposite 
effect by causing an increased rapidity of the natural action 
by which the stomach propels its contents downwards. Ep- 
som salts and Rhubarb exert their purgative action pretty 
equally throughout the whole length of the intestines, while 
the operation of aloes is very much concentrated on the rec- 
tum, or lower extremity of the bowels. Healthy urine pro- 
duces no peculiar effect on the fibres of the bladder, which 
only begin to contract when they have undergone a certain 
degree of distention, but the same urine would produce a very 
different effect upon the bowels if it were received into them, 
as is proved in some cases of surgical injury. 

The involuntary muscles owe their power to a system of 
nerves found in all animals a little complicated in structure — 
even in those that are thought to have no brain or organs of 
voluntary motion. These are the nerves of organic life. 

The arteries, or vessels destined to convey blood from the 
heart, are provided with a fibrous coat similar in many respects, 
both as to appearance and position, to that of the intestines, 
but many anatomists deny that it is muscular; be this as it 
may, the function of those fibres bears a very close resem- 
blance to that of the hollow muscles. The fibres are circular; 
they have a strong degree of tone, and press firmly upon the 
blood within; they yield readily to the gradual increase of 
the circulating fluid, whether it results generally, from high 
living, or locally, from a determination to the part, as in blush- 
ing, and inflammation. They strongly resist sudden disten- 
tion, so that they do not yield to the force of the heart's pul- 
sations, but remain fixed like solid pipes to allow the blood to 
circulate regularly in every part. When a bleeding takes 
place, these fibres slowly contract so as to keep up a constant 
pressure upon the contents of the vessel by diminishing its 
size, but if the blood be drawn away very rapidly or to a great 
extent, they are sometimes unable to contract fast enough, 
their pressure ceases' and the circulation stops, precisely as the 
jet of a fire hose would stop after an extensive breach in the 
conduit that supplies it. This is the cause of fainting, which 
would always prove fatal if the contraction of the fibres were 
arrested by the suspension of apparent animation; but fortu- 
nately such is not the fact; the fibres continue to become 
shorter and shorter until the pressure on the blood is restored; 
the vessels then feel the action of the heart, the circulation is 
re-established, and the patient revives. 

The relative strength of this fibrous coat of the arteries goes 



62 OUTLINE OF ANATOMY. 

on increasing as the vessels divide and become smaller. In 
the larger trunks it seems only designed to adapt the size of 
the vessel to its contents, but in the capillary branches it proba- 
bly influences the force of the current of blood, either by aid- 
ing or counteracting the heart's action; and some say it may 
even continue that current, under certain circumstances, and 
in certain parts, without the aid of the heart 

This coat, that answers all the purposes of a muscle, is much 
under the influence of the nerves, and is supplied with that 
influence by the nerves of organic life; its action is therefore 
altogether independent of the will, but may be powerfully af- 
fected by the mental emotions, like the bowels and other hol- 
low organs. 

The mixed Muscles, or those which are partly obedient to 
the will, and partly involuntary, are chiefly concerned in res- 
piration — a function for which the simplest animals have no 
peculiar apparatus. Even in man it is neither necessary nor 
advisable that the mechanical effort of respiration should be 
going on at all times, because we are occasionally placed in 
situations where such efforts would inevitably occasion suffo- 
cation; as, for instance, when the head is plunged into deleteri- 
ous gases, or when we plunge into the water; and therefore 
we are kindly provided by nature with the means of check- 
ing the operation for a certain length of time. But respira- 
tion is absolutely necessary to the life of a complex animal, 
and it would be very unsafe to intrust the entire command of 
such a function to the discretion even of reasoning man. The 
muscles of respiration are therefore supplied both with n» 
of organic life and voluntary motion. The former hold the 
sway on ordinary occasions, but when dancer threatens, the 
latter soon take the reins, and compel the animal to make the 
effort to breathe, however reluctant he may be, and they even 
continue their exertions, when injury to the brain, or the ap- 
proach of death render him unconscious of his wants. 

The muscles of this class are generally broad, thin, and flat, 
and are not collected into masses like those of voluntary mo- 
tion. The most important of them are, first, the Intercos- 
tal Muscles, a double set placed between the intervals of the 
ribs, so that there are two between each pair of bones, running 
from the lower edge of the one to the upper edge of the next, 
or vice versa. The fibres of these two sets cross each other 
in their direction, and bind the ribs very firmly together. Bj 
their contraction they draw those bones nearer together, and 
as the upper pair of ribs remain nearly stationary, their joint 
operation elevates each successive pair, in a greater and gi\ 
degree, thus dilating the cavity of the chest, especially at it> 
lower part, and causing the air to rush into the lungs. When 



OUTLINE OF ANATOMY. 63 

they relax, the ribs return to their former position, in conse- 
quence of the elasticity of their cartilages and other causes, 
and the air is expelled again. Secondly, the Diaphragm. This 
is a broad and thin muscle, commonly called the midriff, which 
divides the cavity of the chest from that of the belly. Its 
circumference is attached all around to the lower edges of the 
ribs and their cartilages, which we can trace so plainly with 
the hand at the bottom of the chest. Behind, it is attached to 
the spine. This muscle is so very concave below and convex 
above, that it may be likened to a basin turned upside down, 
and the bottom of the basin rises as high as the fourth pair of 
ribs. The heart and lungs lie upon the upper surface of the 
diaphragm, and the liver and stomach fill up its cavity. Its 
fibres run from all parts of the circumference towards its cen- 
tre, but the whole central part of the diaphragm is composed 
of a thin white tendon, and the muscular fibres instead of con- 
verging to the centre are inserted into the edges of this ten- 
don. 

When the diaphragm contracts, the tendon in its centre is 
pulled downward by its fibres, or, in other words, the basin 
is rendered shallower, and consequently, the cavity of the 
chest is then very much enlarged. To fill this enlarged space 
the air rushes in large quantities into the lungs, and this hap- 
pens at the same moment that the intercostal muscles contract, 
all these muscles combine to produce an inspiration. 

But when the basin of the diaphragm is rendered shallow, 
the liver and stomach, with the other bowels, are pushed 
downward, the belly is therefore swelled and its muscles are 
put upon the stretch. The moment the diaphragm relaxes, 
these last mentioned muscles recover their position, the bow- 
els, with the liver and stomach are thrust up again, and the 
air is expelled. This relaxation always occurs at the same 
moment, both in the diaphragm and the intercostals, and thus 
is accomplished the act of expiration. 

There are other muscles which contribute to the act of 
breathing in various ways and under various circumstances, 
but this view of the mechanism of respiration is sufficient for 
our present purpose. More will be added when we come to 
treat of the function of respiration, and the diseases affect- 
ing it. 

Of the muscles of voluntary motion, I need say but little 
here, as they were taken for a model when describing the 
muscles in general, and their appearance and general charac- 
ters are there described. 

That extremity of a voluntary muscle which is attached to 
the more fixed parts, is commonly called its origin, and that 
extremity which is connected with the more moveable parts 



64 OUTLINE OF ANATOMY. 

is termed its insertion. When there is ample room allowed 
for both the origin and insertion of a muscle, and when the 
form of the part is such that its bulk is not productive of in- 
convenience or loss of symmetry, the fleshy fibres run the 
whole distance between the two extremities, and the whole 
organ consists of one great fleshy belly. This is the case with 
the great muscle already mentioned, that covers the shoulder 
joint. It originates from a considerable part of the collar 
bone before, and a still more considerable part of the spine of 
the shoulder blade behind. 

Its anterior and posterior fibres run downward and outward, 
and those that originate from the point of the shoulder, pass 
directly downward, so that they are all collected together at 
their lower extremity into a large rough surface upon the out- 
side of the arm near the middle; and these fibres are fleshy, 
very nearly from one end to the other. 

But if all the bulky muscles of the arm or leg were similar- 
ly formed, it is obvious that the shape and use of the limbs 
would be destroyed, for the thickness of flesh over the joints 
would then be as great as in the middle of the members. To 
avoid this difficulty, many of the muscles are terminated, at 
one or both ends, by white, and very fine cords or membra- 
nous expansions, called tendons, into which the fleshy fibres 
terminate. 

As the tendons are vastly stronger, in proportion to their 
size, than the fleshy bellies of the muscles, they are made to 
occupy less space and to pass on to their insertion without 
crowding the neighbouring parts, or destroy ins: the grace and 
beauty of the person. One of the tendons which furnish the 
best exemplification of these parts is the Tendon of *hhilles, 
so named, because the goddess-mother of the Grecian Hero, 
is supposed to have held him by that part when she plunged 
him in Styx, to render him invulnerable. It is felt by the 
fingers as a rounded riband or cord, behind the ankle joint, 
running from the calf of the leg, to the point of the heel, and 
in this small cord are inserted all the muscular fibres that com- 
pose the fleshy calf. By the simplest mechanical calculation, 
it will be found that when a strong man rises on his toes, lift- 
ing five hundred weight, this little tendon must endure the 
tremendous force of one ton and a half, or two tons, yet in 
bulk, it scarcely equals the little ftftf 

Many of the muscles are provided with tendons at both ex- 
tremities, and it is to this arrangement that we owe most of 
the graceful curvatures that render the human form the most 
exquisite of the beauties of nature. 



OUTLINE OF ANATOMY 
Fig. 8. 



65 




THE ARM WITH THE PRINCIPAL MUSCLE WHICH BENDS THE 
FORE ARM. 



1. The Wrist Joint. 

2. The insertion of 

the muscle be- 
low the Elbow. 

3. A weight in the 

hand. 

4. The muscle with 

its two fleshy 
bellies. 

5. The bone of the 

arm, 

6. The Elbow Joint. 

7. The two tendons 

by which the 
double muscle 
originates. 



The Tendons are white, fibrous, and nearly inelastic. They 
do not differ very widely from the ligaments in structure, and 
are composed, in reality, of cellular membrane very much con- 
densed. The fibres are short and variously interlaced. 

Some tendons are round and slender, like that already men- 
tioned. Most of those of the extremities and spine are of this 
character. They are often confined in their places by liga- 
mentous or cartilaginous rings or sheaths, and where they 
play over each other, or on any hard substance, they are pro- 
vided with sacks containing synovial fluid like those of the 
joints, in order to lessen their friction. 

Sometimes we see one of these round tendons passing 
through a slit in another. This is the case in the hand, where 
the muscle, which moves the third joint of the fingers, lies 
below that which moves the second joint. The former sends 
its long delicate tendons upward, through an opening like a 
button-hole, in the latter, and thus reaches its destination, 
without injuring the symmetry of the second joint. On each 
side of the neck there is a very curious muscle with two 
fleshy bellies connected by a tendon in the middle. It hangs 
like a swing from behind the ear to the chin, and it passes in 
its course, through the body of another muscle, to be attached 
in the middle to the small detached bone that supports the 
root of the tongue. One of the muscles of the eye is still 
more interesting, for its tendon passes over a regular cartila- 
ginous pulley, fixed to the bony top of the orbit; it is then 
doubled back so as to roll the eye in a direction exactly con- 
trary to that in which the muscle contracts. 

There are other tendons, that are broad, thin, and flat, like 

9 



66 OUTLINE OF ANATOMY. 

a sheet of paper. Such a one has been already mentioned as 
forming the centre of the diaphragm or midriff, and several 
others of still greater extent cover the front of the belly. In 
tendons of this character, the fibres resemble a regular net 
work. They are designed to make equal and firm pressure 
over a wide space, and they are more generally met with in 
the mixed muscles. 

Some of the round tendons of the extremities send out late- 
ral expansions which cover and bind down the neighbouring 
muscles, forming regular fascise of greater or less extent. The 
great flexer of the elbow provides one of these tendinous fas- 
ciae to the muscles of the fore arm. 

The Diseases of the Muscles and Tendons are not very 
numerous; their convulsions and their loss of power in palsy, 
being generally caused, not by any change in their own sub- 
stance, but by a derangement in the nerves upon which their 
action depends. The fleshy parts of the muscles are highly 
vitalized, but their sensation, when in health, is obscure, and 
is more nearly allied to soreness than pain. When wounded, 
the feeling produced resembles that of rheumatism. The 
tendons are absolutely insensible, unless when twisted. Di- 
vided muscles unite, like all other parts, by the formation of 
new cellular membrane between the cut extremities; and this 
new bond soon takes on an appearance analagous to tendon. 
It is denied by most, that portions of muscular fibre, when 
once lost, are ever reproduced in their original form. This 
we think a mistake, but it is unnecessary to argue the point 
here. Cancer, Fungus Haematodes, Venereal, &c, some- 
times produce changes of structure in the muscles, not unlike 
those noticed in the bones under similar circumstances. 

The tendons have very little vitality, as they contain scarce- 
ly any blood vessels. When broken or divided, they there- 
fore unite very slowly, and the manner of their union re- 
sembles that of a broken. bone. Their extremities swell and 
become soft, their blood vessels enlarge, and then new matter 
is formed. This requires much time, and at least four months 
should be allowed before a broken tendon should be called 
into strong exertion, although from one to two months is 
often sufficient for a broken bone. A vastly longer period 
elapses before the parts return to their original condition. 

Injuries to the tendons were formerly considered very dan- 
gerous, but this idea is now exploded. The evils dreaded do 
not arise from the wound of the tendon itself, but from that 
of the neighbouring parts. Thus, when a broad flat tendon is 
punctured, the part underneath it may inflame and swell, and 
the pressure of the unyielding tendon makes that swelling ex- 
quisitely painful; or, when a round tendon is hurt, where it 



OUTLINE OF ANATOMY. 67 

passes through a ligamentous canal, the serous or synovial 
membrane which lines the canal becomes inflamed, and such 
inflammations are always serious. Many witloes are of this 
character. 

The muscles vary in strength and size, more than any other 
parts, by exercise and use. They may even become so pow- 
erful as to break the tendons or the bones with which they 
are connected, as is sometimes seen in leaping and dancing. 
Convulsions, and more especially lock-jaw, occasionally cause 
such effects to a horrible extent. 

This peculiar property of the muscles, produces many kinds 
of deformity, gives the characteristic form to the operations of 
particular trades, and not unfrequently lays the foundation of 
consumption and other fatal diseases when exercise is neglect- 
ed or ill regulated. I shall enlarge upon this very important 
subject in the chapter on Hygiene. 

By very violent exertion or by severe blows, the muscles 
interested sometimes lose their power suddenly, never to be 
regained — hence the excessive folly of the extreme exertion 
of strength, particularly at an early age. 



OF THE DIGESTIVE APPARATUS. 

When the food has been properly masticated, it descends 
into the alimentary canal to be subjected to the process of di- 
gestion. 

The alimentary canal is a muscular tube reaching from the 
back part of the mouth to the anus, but in its course it so in- 
volved by turning and doubling upon itself, that if it were 
stretched out in a direct line, it would be found about six times 
the length of the body; that is, a man six feet in height, has 
about thirty-six feet of intestine. 

This canal is essentially composed of two cylinders or coats, 
connected together by a dense cellular membrane which is 
also sometimes styled a coat. The inner cylinder or mucous 
coat is rough, wrinkled, and thrown into numerous folds, as 
if it were much too large for its envelope; it is supplied with 
such immensely numerous blood vessels, that when they are 
minutely injected, they seem in some places to form the whole 
substance of the membrane. It is very plentifully furnished 
with nerves from the system of organic life, and is possessed 
of the highest degree of vital activity and irritability; yet, as 
its nerves have but a very indirect connexion with the brain, 
its sensations, in health, are obscure. Hunger and thirst are 
among the natural sensations of this membrane. At both ex- 
tremities the mucous coat of the alimentary canal is continuous 



68 OUTLINE OF ANATOMY. 

with the true skin that covers the surface of the body, to 
which it bears so strong an analogy, except in the source from 
which it derives its nerves, that it may be regarded as a kind 
of internal skin. At the two points just mentioned, it receives 
more twigs from the nerves of sensation, and enjoys a higher 
degree of sensibility. 

The cuticle or scarf skin is continued into the upper extre- 
mity of the canal, as far as the stomach, but becomes so deli- 
cate, that it is difficult to detect its presence. In all the in- 
tervening space between this, and the immediate neighbour- 
hood of the anus, the cuticle is wanting, and the membrane is 
protected only by the mucus, which it pours out upon its in- 
ner surface. When this mucus is removed by inflammation, 
or by purging in diarrhoea or dysentery, the bowels become 
liable to severe irritation from slight causes, for they are then 
reduced to a condition not unlike that of a blistered surface, 
after the cuticle has been entirely removed; hence, the vast 
mischief often resulting from the use of very severe medicines 
in sucji cases, for by violent measures pursued with the inten- 
tion of " removing impurities," we remove also the natural 
protection of this extremely delicate surface. This happens 
the more readily because the peculiar character of the nerves 
of the bowels prevents them from giving early notice of the 
danger. 

The mucous coat contains also the smallest branches of mil- 
lions of the lacteals or little vessels, which imbibe the nutri- 
tious parts of the food, in order to convey it to the heart, and 
circulation, as was mentioned in our first hasty sketch of the 
principal functions of an animal at the commencement of this 
work. 

The outer cylinder or coat of the alimentary canal is com- 
posed entirely of the muscular fibres already described, when 
speaking of the involuntary muscles, with the cellular tissue 
connecting together those fibres, and the vessels and nerves 
that supply them. The principal trunks and branches of the 
vessels and nerves of the mucous membrane penetrate this 
coat in countless numbers. 

The muscular coat enjoys scarcely any sensibility in health, 
as it derives its nerves from the system of organic life, but 
when it is affected by inflammation or spasm, it becomes 
acutely painful, as we see in cholic and many other diseases. 

The use of this membrane is to thrust the food onward as it 
undergoes the process of digestion, and this it accomplishes 
by the successive contraction, first, of its upper fibres, and then 
of those beyond, in due order, thus forcing the contents be- 
fore them. When, however, any insurmountable barrier is 
opposed to the progress of the food, or when the individual 



OUTLINE OF ANATOMY. 



69 



has taken a powerful emetic, this action is reversed to a greater 
or less extent, and the partially digested food is ejected by the 
mouth* 

Fig. 10. 




A, A. A portion of small intestine. 
by 6, b, b. Superficial lacteals. 

c, c, c. A portion of mesentery, or that double fold of peritoneum which 

binds the small intestine to the spine. 
d y d y d. The first range of mesenteric glands, receiving the small branches 
of the lacteals from the intestine, and transmitting a few larger 
branches to the second range. 
C, c, e. The second range of mesenteric glands, collecting the branches 
of lacteals into still larger trunks. 
fy f. The receptacle for the chyle and lymph, being a slight enlarge- 
ment of the thoracic duct at its commencement. 
g. The thoracic duct. 

h. The aorta or principal artery of the body. 
i. Lymphatics coming up to the thoracic duct. 



70 OUTLINE OF ANATOMY. 

In addition to the two coats just mentioned, all that portion 
of the canal which is enclosed in the cavity of the abdomen 
or belly, is covered externally with a smooth serous mem- 
brane called the peritoneum, to which allusion has been made 
already. This membrane, after very loosely enveloping the 
bowels, passes off from the posterior parts of the tube in a 
double fold, like a towel hanging upon a line, leaving only a 
narrow strip of the bowel uncovered behind. (Fig. 10. c.) 
Between these folds the principal vessels of the intestines pass 
from the great trunks near the spine to their destination, and 
the lacteals (b.) gradually collecting themselves into a few 
large branches, pursue their route toward the thoracic duct, into 
which they are all emptied, that their contents may be con- 
veyed by that vessel to the great veins, and thus to the heart. 

The double fold of peritoneum coming from the bowels is 
attached diagonally across the spine, and thus serves to bind 
the intestines at a proper distance from that column, and to 
prevent them from getting entangled, while it allows them 
great freedom to enlarge or contract, or to perform their other 
necessary motions. The folds are then reflected over the sides 
of the cavity of the belly, which are thus entirely covered by 
the peritoneum, so that this smooth membrane is every where 
placed in contact with itself, and as it is kept constantly moist 
by its proper serous secretion, all friction between the sides of 
the belly and the bowels is effectually prevented. The gullet 
before it passes through the midriff into the abdomen and the last 
intestine, after it leaves that cavity and enters the pelvis, are 
the only parts of the canal not covered, wholly or in part, by 
the peritoneum; it is therefore common to call this membrane 
the third coat of the bowels; or, if the cellular substance which 
envelops the mucous and muscular membrane be included un- 
der the name of the nervous coat, as it is by some, then the 
peritoneum forms a fourth coat to the intestines. 

The arrangement of the peritoneum is very complex, and 
furnishes a most wonderful display of the goodness and wis- 
dom of providence in protecting the important organs which 
it covers; but it is impossible to describe it in detail without 
transcending our reasonable limits. Nor is it proper to speak 
at present of the diseases of the bowels; they are numerous 
and will be described hereafter. 



OF THE FUNCTION OF DIGESTION. 

The food during mastication is broken into small pieces or 
it is crushed and mingled with the saliva. This proce.-- - 
highly important, for if the various aliments were taken 



OUTLINE OF ANATOMY. 71 

the stomach in their crude state, they would often prove very- 
irritating to its delicate surface, and their solidity might ren- 
der their digestion slow, imperfect, or even impossible. 

The saliva is secreted by a number of small glands situated 
about the mouth, each of which is provided with a little duct 
or canal to convey its fluid into that cavity. 

Of these glands the largest are placed beneath the ear and 
behind and upon the angle of the lower jaw, on each side. 
Their ducts are seen opening on the inside of the cheek opposite 
the second great grinding tooth. When the mouth is opened 
suddenly we often see clear jets of saliva thrown very forcibly 
into the mouth from the orifices of these ducts. This gland 
sometimes becomes inflamed, and it is very singular that this 
affection often prevails epidemically under the common name 
of the Mumps. It seems to depend on the same general causes 
with Influenza, and may be considered as a variety of that 
disease, expending its force chiefly on the salivary organs. 
The gland is called the parotid, and the inflammation is de- 
scribed in the books under the title of Cynanche Parotidea. 

Two smaller glands of the same nature lie immediately in- 
side of the angles of the lower jaw, and discharge themselves 
by two long and winding ducts terminating on the sides of 
the bridle of the tongue. They are called the sub-maxillary 
glands, and when swelled by cold, or in the mumps, they be- 
come very obvious, and are commonly called kernels. 

Besides these, there are two others — the sub-lingual glands — 
which we see hanging like a fringe on each side of the bridle 
of the tongue. They empt}^ their contents through a great 
number of very small, short ducts, which cannot be detected 
without close attention. 

The canals of the salivary glands may be obstructed by in- 
flammation, or by the formation of stones like those of the 
bladder, and such accidents may be recognised at once by the 
rapid enlargement of the gland affected, which does not be- 
come immediately hard, as it always is when inflamed, but 
continues soft, and yields to the pressure of the finger until 
the distention is carried very far. Such cases require the 
prompt assistance of a surgeon. 

When external wounds penetrate these canals, if they are 
not immediately closed and healed, the constant flow of sali- 
va often keeps them open, and the fluid, instead of reaching 
the mouth, is poured out upon the cheek. This is an unfortu- 
nate accident, and requires the utmost skill to effect a cure. 

The saliva not only has a powerful influence in keeping the 
particles of food separate from each other, so as to render their 
passage into the stomach easy and facilitate the action of this 



72 



OUTLINE OF ANATOMY. 



organ upon them, but it also assists in dissolving the food, and 
thus promotes digestion. Any thing, then, that tends to vi- 
tiate the quality or diminish the quantity of saliva is necessa- 
rily injurious to health. 

To return to the food and its progress. When it has been 
properly divided, and mingled and coated with saliva, it is 
thrust backward by the tongue. The orifice of the windpipe is 
then closed by its muscles and the curious little cartilage which 
acts as a lid to that orifice is shut down, so that the food passes 
safely over it, to the opening of the gullet. When by acci- 
dent this lid is not closed in time, the food comes in contact 
with the exquisitely sensitive edge of the wind pipe, pro- 
ducing a vioient spasmodic closing of the tube, to prevent the 
passing matter from entering the lungs. 

Fig. 11. 




THE STOMACH. 



A, A. Anterior Surface. R. Enlargement of the lower part. D. Cardiac 
orifice. F, andC. Principal arteries of the stomach. II. The omentum or caul 



OUTLINE OF ANATOMY. 73 

How uncomfortable this accident is, must be well known to 
all who have had the misfortune to ** swallow a drop the 
wrong way." 

Once fairly placed in the commencement of the alimentary 
canal, the food is urged onward by the alternate action of the 
circular fibres of the muscular coat of the gullet until it is 
fairly forced into the stomach. 

The Stomach (fig. 11.) is the first great enlargement of the 
alimentary canal. It is shaped somewhat like a great blad- 
der, but its upper and lower orifices are near together, but 
being placed far back toward the spine. 

Its position is such that its course lies nearly cross-wise 
with regard to the body, so that one of its sides, when the or- 
gan is full, lies partly in contact with the hollow of the dia- 
phragm or midriff, and partly with that of the under side of 
the liver, while the opposite side rests on the intestines. 
(Fig. 15, o.) The gullet enters it immediately after passing the 
diaphragm, on the left side of the column of the spine, and 
the small intestine passes out from it, on the right side of the 
same column, a little lower down. 

The small arch of the stomach, which rides like a saddle 
over the bodies of the vertebrae, from one orifice to the other, 
is very short and is called the lesser curvature; but the great 
arch sweeps in from the entrance of the gullet far round the 
left side and the front of the belly, under what we call the pit 
of the stomach, and so returns to the place of exit for the 
small intestine, on the right side of the spine: it is very long, 
and is termed the great curvature. The stomach thus formed 
and placed, bears considerable resemblance to a retort, with a 
very short neck, bent until it nearly touches the bottom. 
The great bulge of the retort lies to the left and in front, the 
neck to the right and behind; the throat sits over the spine, 
and the sides approach the horizontal position, the great end 
being a little the higher. If we conceive the gullet to enter 
the bottom, and the small intestine to be connected with th 
neck of the retort, we shall have no bad idea of the form ana 
position of this important organ. 

The food remains in the stomach a considerable length of 
time, until it is gradually dissolved and converted into a semi- 
fluid mass, from which the lacteais can extract the proper 
nourishment. 

The whole process of digestion is a wonder and a mystery. 
The food, while the stomach is in a healthy condition, is com- 
pletely protected against those changes which would take 
place in the same period of time in the dead body, and all the 
alterations which it undergoes are the direct effect of actions 
purely vital, which chemistry can neither imitate nor explain. 

10 



74 OUTLINE OP ANATOMY. 

By some unintelligible power, the different articles of food 
taken, during a meal, are kept wonderfully distinct, and the 
stomach appears to act chiefly upon one at a time, always se- 
lecting those first which are most easy of digestion, drawing 
them towards its surface by some unknown species of attrac- 
tion. 

It is always the outside of the mass of food that undergoes 
digestion first, and when this layer is fully prepared, it is passed 
on into the small intestine, by the regular action of the mus- 
cular fibres of the stomach, and another layer of food is then 
attacked and disposed of in the same manner. Whatever is 
difficult of digestion, whether in consequence of imperfect 
mastication of the peculiar nature of the substance, remains to 
the last, and if the powers of the stomach are exhausted, or 
the food proves very refractory, it becomes a source of irrita- 
tion and disease Hence, the serious consequences to the 
health, from the early loss of the teeth, and hence, also, the 
wide spread prevalence of dyspepsia, from that most vulgar 
of our national habits, the custom of eating' our meals with 
disgusting rapidity. 

It is a fact that should never be forgotten, that the stomach 
loses much of its power of digestion during sleep, so that if 
suppers be taken immediately before going to bed, the organ 
is compelled to undergo the irritation resulting from the pre- 
sence of crude food for many hours together. This out 
upon nature is never tolerated with impunity; imperfect slum- 
bers, night-mare, diseases of the heart, sometimes epilepsy, 
gout, dyspepsia, &c. stand ready to revenge it, and one or 
other of these ministers of justice is sure to punish the vic- 
tim of this species of dissipation. When an hour or two in- 
tervenes between the meal and the repose, the evil is mate- 
rially lessened, though not entirely removed, for in that time, 
a surface of digested matter is every where presented to the 
stomach, and the oppression from the weight of its contents is 
the only cause of uneasiness. 

It is hardly less injurious to use very active exertion of 
body or mind immediately after eating. The agitation of 
the stomach and its contents disturbs the order of digestion 
and brings portions of crude matter into strong collision with 
the tender mucous membrane. Moreover there is always a con- 
centration of vital energy in the stomach during digestion: the 
blood leaving the surface, which becomes cool and sometimes 
even chilly, and flying in unusual quantities to the alimen- 
tary canal. Soon after this the action of the heart is increased 
and the whole circulation is rendered more vigorous to ena- 
ble the stomach to effect its purpose. Now when the mus 
cles, brain, or indeed any other organs are called into strong 



OUTLINE OF ANATOMY. 



75 



exertion, they require a similar increase of blood to heighten 
their powers, and it is wrong to distract the vital energies by 
calling unnecessarily for their operation in various and distant 
parts at the same time. (See chapter on Hygiene, tflrt. Food.) 
The changes that the food undergoes in the stomach have 
been attributed by most to the operation of a peculiar fluid 
supposed to be secreted by the vessels on the internal surface 
of the organ, and commonly known by the title of the gastric 
liquor. The very existence of this fluid has been denied by 
some, but it is unnecessary to argue the point in a popular 
treatise. It is sufficient to remark that the changes just men- 
tioned consist in the gradual conversion of the whole mass of 
contents into a semi-fluid substance called chyme, mingled oc- 
casionally with matters absolutely indigestible, swallowed ne- 
cessarily or by accident with the food, such as the skins or 
cuticle of vegetables, cherry stones, pieces of bone, &c. &c. 



Fig. 12. 




SUCTION OF STOMACH. 



A. The extremity of the gullet or oesophagus entering the stomach. 

B. The cavity of the stomach. 

C. The pilorus or outlet of the stomach. 

D. The duodenum. 



The Chyme thus constituted is propelled by the stomach 
into the first part of the small intestine, commonly called the 
duodenum, (D.) because its length is about equal to the breadth 
of twelve fingers. Here the chyme undergoes a kind of second 
digestion before it is presented to the lacteals to be absorbed. 

The duodenum has been considered by some as a second 
stomach. It is a narrow gut commencing at the lower orifice 
of the stomach on the right side of the spine, and passing near- 



76 



OUTLINE OF ANATOMY. 



ly horizontally over to the left. At the junction of this intes- 
tine with the stomach there is a strong band of circular fibres, 
which close the canal by their contraction, and thus prevent the 
return of the chyme into the latter organ, (fig. 12. C.) At the other 
extremity, the duodenum is continuous with the remainder of 
the small intestine. There are two great glands which pour 
their secretions into this part of the alimentary canal, and as 
their agency is all-important to the due performance of the 
function of digestion it is best to notice them here. 



Fig. 13. 




A. Right lung. 

B. Left lung. 

C. Right ventricle of the 

heart. 

D. Right auricle of the 

heart. 

E. The great vein de- 

scending from the 
head and upper ex- 
tremities, called the 
vena cava. 

F, F. The principal veins 

from the arms coming 
to join the great 
vein. 

G, G. Internal jugular veins 

coming from the 
head. 

H. The great artery of 
the body called the 
aorta. 

I. Pulmonary artery. 

K. Diaphragm. 
L, L. Right and left lobes 
of the liver. 

M. Round ligament of 
the liver. 

N. The gall bladder. 

O. Stomach. 

P. Spleen. 
Q, Q. Situation of the kid- 
neys behind the in- 
testines. 
R, R, R, Small intestines. 



THOIIAC1C AND ABDOMINAL VISCERA. 



The Liver is by far the largest gland of the body, it fills up 
the principal part of the hollow of the diaphragm on the right 
side, and extends considerably over to the left of the middle 
line of the body. Above, it is very convex, but below, it is 
slightly concave. The hinder edge is very thick and rounded, 
but the front margin is thin and well defined. The stomach. 



OUTLINE OF ANATOMY. 77 

when fully distended, fills up a considerable part of its conca- 
vity. It is much thicker and more massive on the right side, 
and gradually becomes attenuated as it approaches the left side 
of the cavity of the belly, which it never quite reaches, a part 
of the great end of the stomach being placed between the liver 
and the latter part. The lower and front edge corresponds 
very nearly with the margin of the ribs, and seldom passes 
below that line unless when enlarged by inflammation or long 
continued fevers. It is divided into several lobes and is kept 
in place by several double folds of the peritoneum, which co- 
vers the greater part of its surface, and is then reflected on to 
the walls of the belly. So great is the weight of this organ, 
however, that in falls from a great height, it has been known 
to tear its attachments, and even to crack its own substance, 
so as to produce speedy death. 

The liver thus placed receives nearly all the blood returned 
from the bowels toward the heart; the vital current being con- 
veyed to all parts of its substance by the appropriate vessels, 
which will be described when we come to consider the sub- 
ject of the circulation. From this blood is secreted the bile, 
the peculiar fluid elaborated by this gland, and the bile is re- 
ceived, immediately on its formation into the minute branches 
of the gall duct, which are found in every part of the liver. 
These branches are gradually collected into larger trunks, 
which are united continually with each other until they all 
disgorge themselves through one great canal which passes into 
the duodenum. But in order that this powerful fluid should 
be reserved in sufficient quantities to answer the demands 
made upon it under extraordinary circumstances, there is a 
large reservoir adhering to the concave surface of the liver, 
which communicates with the duct by a short canal. Into 
this reservoir the bile flows backward when its presence in 
the duodenum is not required, (fig. 13. N.) 

The exact duty which the bile performs in the business of 
digestion is not understood, but it appears necessary that a 
portion of it should be mingled with the chyme, before the 
nutritious parts of that mass are prepared to be taken up by 
the lacteals, to be mingled with the blood. 

Moreover, the bile is the natural purgative, and its presence 
is highly necessary to quicken the motions of the bow r els in 
urging forward the useless parts of the food, in order that they 
may be discharged from the body. When the bile is vitiated 
in quality, or increased in quantity by disease, it often acts 
with violence, producing severe and even dangerous purging, 
and when it is greatly diminished in quantity, obstinate cos- 
tiveness is the ordinary consequence. 

Healthy bile produces no uneasiness in the duodenum, but 



78 OUTLINE OF ANATOMY. 

its presence cannot be tolerated in the stomach. Whenever it 
finds its way into that organ, it produces vomiting and is im- 
mediately thrown up. This fact gives rise to a popular error 
in practice which is productive of vast mischief, particularly in 
the Western country. I allude to the too free use of emetics 
under the supposition that the patient is bilious. An emetic 
reverses the natural action of the stomach, and if severe, it 
extends its influence to the duodenum. In that case the con- 
tents of the latter intestine, and of course the bile, if any be 
present, instead of passing on to the small intestine are re- 
turned into the stomach, where they occasion terrible uneasi- 
ness, and the vomiting is continued until all the bile is thrown 
up. This presence of bile in the discharges is taken by the 
ignorant observer, for a proof of the correctness of the prac- 
tice. "See what a quantity of bile he had on his stomach; 
he needed the emetic badly." Now the reader may be some- 
what surprised to hear that this very bile was actually brought 
into the stomach by the very emetic given to evacuate it. If 
a powerful emetic is given to a man in health/ — as soon as the 
contents of the stomach are thrown up, bile follows, inevitably, 
not because it previously existed there, but because the medi- 
cine has called it there! Emetics are among the most effi- 
cient means of promoting the secretion of bile, and if that 
fluid is already too copious, great mischief may result from 
their action. 

The bile poured into the stomach on such occasions often 
keeps up the vomiting until the patient dies of exhaustion, or 
until the over exerted liver loses its power and the secretion 
stops. In the latter case the patient recovers, with a long con- 
valescence, a stomach without a tone, and a liver without en- 
ergy, and too frequently the medicine is lauded for saving him 
from the desperate situation into which it had reduced him by 
its own agency! Emetics are valuable remedies in their pro- 
per place, but let it be remembered that the natural course of 
the bile is downward. 

The Pancreas is a long, narrow gland placed in contrast 
with the posterior walls of the belly, behind the peritoneum. 
It resembles the salivary glands both in its form and in its pe- 
culiar secretion. Its duct is constructed like that of the liver, 
except that it has no reservoir attached, and it empties into 
the duodenum, by an orifice almost in contact with that of the 
gall duct — indeed, they are sometimes united before they en- 
ter the intestine. 

The process of digestion is by no means completed in the 
duodenum, for the food is constantly undergoing changes 
throughout the whole extent of the alimentary canal. The 
greater part of the nutritious matter, however, is extracted in 



OUTLINE OF ANATOMY. 79 

the duodenum, and by the aid of the bile and pancreatic liquor, 
it is converted into a milky fluid, called chyle. 

The Chyle, together with the remaining parts of the food 
pass on into the other portions of the small intestines, where 
the former is very rapidly absorbed by the open mouths of 
the lacteals to be carried into the circulation. 

It is a curious fact that however various the quantity of the 
food taken into the stomach may be, the chyle obtained from 
it is always of the same nature. Some few substances not pro- 
perly belonging to this fluid, may enter with it and mingle 
with the blood, but they are almost immediately thrown out 
again from the body, either in the urine or in some other ex- 
cretion, so that the purity of the blood is effectually preserved. 

The small Intestine is divided by surgeons into the jeju- 
num and the ileum, but this division is arbitrary, and I shall 
not notice it farther. 

After leaving the duodenum, which terminates on the left 
side, this intestine is rapidly separated to a distance from the 
spine, nor does it again approach to the walls of the belly, until 
its lower end enters the great intestine near the right hip. Al- 
though its two extremities are separated but a few inches from 
each other, the tube travels many yards in passing from the 
one to the other. It winds about and doubles upon itself in 
every possible direction, until it fills the whole of the middle 
and lower part of the belly, and even descends some distance 
into the pelvis or basin when the bladder is empty. Now 
these folds of intestine would be constantly liable to become 
entangled and misplaced, were it not for the curious arrange- 
ment of the double fold of the peritoneum, which after cover- 
ing the bowels, runs to be connected with the walls of the bel- 
ly behind, in the manner already described. 

This double fold acts like a ligament, binding the whole 
length of the small intestine at a proper distance from the 
spine, without interfering with its necessary motions. 

The hinder part of this duplicative is stretched obliquely 
across from the upper to the lower end of the gut, adhering 
strongly to the back of the cavity of the abdomen; but its 
front edge, where it divides to embrace the intestine is length- 
ened out like the free margin of a fan, or shirt frill, or a half- 
opened umbrella, so that it follows all the windings of the ca- 
nal. 

The mucous coat of the small intestine is not only too large 
for the muscular cylinder in which it is enclosed — like that of 
other parts of the alimentary canal — but it is likewise much too 
long; so that in addition to the longitudinal wrinkles seen in 
all the bowels, it is also thrown into large, circular folds that 
hang loosely in the cavity and considerably diminish its di- 



80 



OUTLINE OF ANATOMY. 



ameter. These folds are so numerous near the upper extre- 
mity, that they actually overlap each other as the food passes 
by them, but near the lower extremity they become smaller 
and less numerous until they finally disappear. The principal 
use of these folds or valves, as they have been termed, is to 
increase the surface in contact with the food, and as the whole 
mucous coat of this bowel is so covered with little projecting 
twigs of nerves, and capillary branches of blood vessels and 
lymphatics, that its surface resembles fine velvet, every part 
of the digesting mass must necessarily be acted on, and not a 
drop of the chyle can escape the millions of little mouths al- 
ways kept open to drink it in: — at least this is the case during 
health. 

Fig. 14. 




VALVE AT Till: EXD OF THE SMALL INTESTINE. 

a, c. Small intestine, b, b. Large intestine. 

d. A little worm-like appendage of the large intestine. 

By the time the remains of the food have reached the lower 
extremity of the small intestine, nearly all the nutritious mat- 
ter has been extracted from it. and it is reduced to a soft mass 
of faeces and mucus mingled with a little water and other flu- 
ids. It is then forced into the commencement of the great 
intestine, which is placed on the right side of the spine near 
the wing of the share bone. The opening of the small, into 
the great gut is guarded by a curious valve, formed by an 
elongation of the coats of the former, which are sloped inward 
from each side until they leave nothing but a narrow slit, 
through which the contents may pass downward by pushing 
the valve open, but if they attempt to return the valve is in- 
stantly closed, and they are arrested. 



OUTLINE OF ANATOMY. 81 

The Great Intestine is many times larger than either the 
duodenum or the remainder of the small intestine, and it is 
much less regular in shape, being furnished with several strong 
longitudinal bands.of fibres which indent it lengthwise, and also 
with numerous circular contractions intersecting these bands 
at short intervals, and dividing the whole surface into small 
squares. In the intervals between the depressions, the intes- 
tine bulges outward, forming as many little domes in which 
the faeces accumulate and become moulded into the shape that 
they generally present when discharged, particularly with cos- 
tive patients. This part of the alimentary canal is still pro- 
vided with some absorbent vessels, that take up the fluid por- 
tions of the contents and gradually harden the fasces; so that 
when they are long retained in consequence of disease or in 
old age, they are often discharged with the greatest difficulty. 

That part of the great intestine that lies in the cavity of 
the abdomen is called the colon, and the lower portion, which 
passes through the basin to the anus, is termed the rectum. 

The Colon is swelled out, at its commencement, into a large 
receptacle, called the head of the colon; the small intestine 
enters it at some distance from the end, and in a direction 
nearly at right angles to its course. This arrangement assists 
the valve in preventing the return of the faeces. 

From the lower part of the right flank the colon runs up- 
ward along the flank, near the spine, until it rises almost to 
the level of the stomach. It adheres to the right kidney, and 
continues upward until it comes into contact with the duode- 
num and the gall bladder. It then suddenly springs in an arch 
all across the belly, touching the lower side of the liver, and 
passes immeidately below, or sometimes, in front of the sto- 
mach, covering and concealing the duodenum. It passes im- 
mediately along the front walls of the abdomen, and rests on 
the convolutions of the small intestines. After reaching the 
left flank, it turns abruptly downwards, adheres to the left kid- 
ney, and then finishes its course by a kind of double curve to 
the right again, terminating at the body of the last lumbar ver- 
tebra, where it is continued into the rectum. 

Thus far the remains of the food, now converted into pro- 
per faeces, are propelled by the agency of the bowels them- 
selves, but their final ejection cannot be accomplished in health 
without the aid of the will. 

The whole digestive apparatus, except the parts about the 
mouth, the gullet, and the rectum, are placed in a large enclo- 
sure called the cavity of the abdomen. This cavity is bound- 
ed above, by the diaphragm, the great muscle of respiration 
already presented to notice; below by the cavity of the basin, 
filled in males by the bladder and rectum, but, in females, con- 

11 



82 



OUTLINE OF ANATOMY". 



taining also the womb and other organs of generation; behind, 
by the lumbar portion of the spine; and at the sides and front, 
by the wings of the share bone, and a number of broad, flat 
muscles with their tendons — which fill up all the interval be- 
tween the brim of the pelvis to the lower margin of the ribs, 
their cartilages, and the breast bone, from the spine, be- 
hind, to the middle bone of the body before. The whole of 
this cavity is lined by the smooth delicate serous membrane 
called the peritoneum, which has been already described, and 
it is completely filled by the stomach, intestines, and the other 
bowels, with their nerves, vessels, &c. 



Fig. 15. 



a. The cavity of the chest or thorax. 

b. The cavity of the abdomen. 

c. The line of direction for the dia- 

phragm when relaxed in expira- 
tion. 
d. The line of direction for the dia- 
phragm when contracted in inspi- 
ration. 
e,f. The front walls of the chest and ab- 
domen. 
The spine, in this figure, is seen in 
side view, and divided through the 
middle of the canal for the spinal 
marro\r. 



\ ; Our limits will not allow us to 
; ; dwell on the highly interesting and 
! i pcurious arrangement of the diffe- 
jr rent abdominal muscles: their in- 
fluence on respiration has been no- 
ticed above, but on their joint ef- 
fect in aiding the function of di- 
gestion, a few words may be add- 
ed. 

It will be perceived that the 
greater part of the alimentary ca- 
nal is enclosed in a cavity, surrounded by broad and strong 
muscles on every side except toward the pelvis or basin, where 
it rests upon the bladder and rectum. The former of these 
organs is only separated from the superincumbent intestines, 
by a thin layer of peritoneum covering its upper surface and 
forming the floor of the abdomen. When all the muscles 
contract together, the bowels are pressed downward by the 
diaphragm, and they are at the same time forced inward by 
the muscles surrounding the flank and front of the belly: the 
only direction in which they or their contents can yield to 
this pressure, is toward the pelvis, where there is no muscle 
to oppose them; they, therefore, compress the bladder ant! 




SECTION OFTnORAX AND AHDOMLy. 



OUTLINE OF ANATOMY. 83 

turn so as to compel them to evacuate the urine and faeces, and, 
in this manner, the will of the individual aids the muscular 
coat of those organs and determines the moment of discharge. 

The same forces operate in producing vomiting, when any 
obstacle to the natural passage of the food exists; for then the 
contents of the stomach are pressed upward through the gul- 
let, the only practicable outlet. The motions of the abdominal 
muscles in vomiting are commonly spasmodic, and very pow- 
erful. 

These muscles also contribute greatly to hasten the move- 
ments of the fibres of the muscular coat by their constant and 
alternate action in respiration; for varied pressure and agita- 
tion act as stimulants to a muscle, and promote its contractions: 
hence the frequency of stools after unusual exercise. 



OF THE CIRCULATION. 

Some very general ideas on the subject of the circulation 
have been already given in the preceding chapter, and in order 
to avoid unnecessary repetition, the reader is requested to 
glance his eye over the outline there given, (p. 20, 21,) and 
also over the remarks under the head of the involuntary mus- 
cles, where the fibrous coat of the arteries is mentioned, (p. 
59, 62.) I shall then consider him familiar with the meaning 
of the terms artery, vein, capillaries, lacteals, absorbents, 
fibrous coat, serous coat, &c, and shall employ these terms 
hereafter without farther definition. 



OF THE CIRCULATING FLUIDS. 

The circulating fluids, like all the solid parts of the body, 
are supposed to possess vitality, that is, they are compounded 
in a manner which chemistry cannot explain, and they per- 
form operations unintelligible to the student of inanimate na- 
ture. Their peculiar form and character are gradually lost, 
after the death of the body, when death results from mild 
causes, and the same changes are observed in them when re- 
moved from the body in health. In the latter case, if the flu- 
ids be instantly transferred to the proper vessels of another 
individual, they retain their vitality and sometimes produce 
very little disturbance. But some very violent fevers, the worst 
form of spasmodic cholera, and more especially great shocks 
of electricity and lightning, affect the circulating fluids as they 
do the tonicity of the muscles, the cohesion of certain other 
solids, &c; that is, they suddenly or instantaneously destroy 



84 OUTLINE OF ANATOMY. 

all traces of life, not only in the human frame, but in the fluids 
likewise. 

These facts are sufficient to prove that chyle and blood par- 
take of the mysterious principle called life, in common with 
all other portions of the body; although the progress of mo- 
dern science has displaced the old opinion founded on the let- 
ter of the Mosaic Law, that the blood is the peculiar seat of 
the vital principle. 

The first branches of the lacteals are so small that the qual- 
ities of the chyle that they contain cannot be ascertained with 
certainty; but when the fluid reaches the thoracic duct, it is 
white, opaque, devoid of smell, and has a somewhat acid and 
decidedly sweetish taste. It is composed, like the blood, of 
solid globules floating in a liquid. When removed from the 
body, it speedily separates; one part becoming solid like the 
clot of blood observed in the bowl the day after a bleeding, 
but wanting the red colour; the other portion serous, like the 
fluid that surrounds the clot. The solid part of.the chyle seems 
to possess properties intermediate between those of the serous 
portion and the clot of the blood, being converted into the lat- 
ter substance after it enters the circulation. The fluid parts, 
both of the chyle and the blood are coagulated by heat, like 
the white of an egg when boiled — and this coagulation seems 
to constitute one of the principal changes that takes place when 
the liquid matter of the circulation is deposited, in order to 
form the white solids of the body, such as simple cellular tis- 
sue, tendons, ligaments, &.c. 

The chyle contains all the most important elements that are 
necessary to the formation of the various organs of the ani- 
mal: these are oxygen, or vital air; chlorine, or the bleaching 
gas; nitrogen, that portion of the atmosphere which cannot be 
breathed alone; hydrogen, or inflammable air: carbon, or pure 
charcoal; phosphorus, the metallic bases of soda and lime; and 
iron. Potash and magnesia are the only ingredients found in 
blood that are not enumerated in the list of results from the 
analysis of chyle, but the absence of these articles cannot be 
inferred with certainty. The mode in which these elements 
are combined in the two fluids differ* much more widely. 

The blood is a fluid so familiar to all, that little need be said 
of its general appearance. It divides, when removed from the 
vessels, into two portions, the coagulum or clot, and the se- 
rum. The solid part has a strong red colour, but when broken 
to pieces and repeatedly washed, it becomes white and fibrous 
in its appearance, and the colouring matter is transferred to 
the water. 

In the simplest animals, those which have no muscles, the 
animal juices, which may be termed their blood, display no dis- 



m 

OUTLINE OF ANATOMY. ' 85 

position to separate into a solid and a fluid portion. In those 
that have muscles of a white colour and sluggish action, like 
the reptiles, the blood contains the white fibrous matter of the 
clot, but wants the coloured globules. Even in man those 
muscles which are kept most constantly in rapid motion have 
the deepest colour, while those which act slowly and with lit- 
tle power, like the fibrous coat of the intestines, are compa- 
ratively pale. Want of proper exercise renders all the mus- 
cles pale and feeble, and diminishes the size of the clot of 
blood. 

Hence it is fair to infer that the solid part of the circulating 
fluids is designed to support the muscular system generally, 
and that the red matter gives that system its highest degree 
of strength and activity. The coloured globules of the blood 
contain also some of the materials necessary to the formation 
of other parts, and particularly the bones; but they are evi- 
dently decomposed and deprived of their crimson hue before 
they enter these parts — while in the muscles their proper cha- 
racter appears to be in a great degree retained. 

The serum of the blood, contains most of the various ingre- 
dients necessary to the formation of the white parts of the 
body, and probably supplies them with nearly all their nou- 
rishment. The principal ingredients of serum are albumen, 
or the same substance that forms the white of an egg, and water. 
When heated, this fluid coagulates and is then reduced to a 
condition that strongly resembles the matter of many of the 
white solids, at least so far as its chemical properties are con- 
cerned. The fluids of all the serous cavities — that thrown out 
by blisters, and the effusion in dropsy — are of the same charac- 
ter, and do not differ much from each other. 

The blood that flows from the lungs to the heart, to be 
driven out again to supply all parts of the body, is of a bright 
crimson colour; but that which returns from all parts of the 
body to the heart, that it may be driven into the lungs, is of 
a dark purple. The chief cause of this difference of colour is 
the greater amount of charcoal contained in the returning 
blood, which is supposed to result from the changes that take 
place in the capillaries, which vessels separate from the mass 
of circulating fluid much of its other materials and leave an 
excess of the carbonic matter. This excess is thrown out from 
the body by the act of respiration, in the form of fixed air or 
carbonic acid gas, and by the secretion of bile, which contains 
it in considerable amount. 



86 



OUTLINE OF ANATOMY. 



OF THE ROUTE OF CIRCULATION. 

The heart lies on the left side of the chest, where it is en- 
closed in a bag or sack of serous membrane, adhering to the 
diaphragm or midriff on its upper surface, and suspended 
above by its connexions with the great blood vessels as they 
enter the heart. This sack, after surrounding the heart, is fold- 
ed inward upon itself so as to cover the external surface of the 
roots of the great vessels and the heart also, being applied to 
the organ, in the same manner that*the peritoneum is applied 
to the bowels and walls of the belly. It contains a little mois- 
ture at all times, so as to give the organ free play, and to pre- 
vent friction. When this moisture is much increased, it pro- 
duces that most fatal disease, the dropsy of the pericardium. 




THE HEART A>"D GIIEAT BLOOD VESSELS. 



1 . The right Auricle, which 

receives the blood from 
the body in general. 

2. The right Ventricle, which 

drives the blood to the 
lungs. 
3 • The left Ventricle, which 
receives the blood from 
the lungs. 

4. The left Ventricle, which 

drives the blood to the 
body in general. 

5. The pulmonary artery 

coming from the right 
Ventricle. 

6. Its branch which goes to 

the left lung. 

7. Its branch which goes to 

the right lung. 

8. The Aorta, or Great Ar- 

tery going to the body 
in general, from the left 
Ventricle. 

9. The descending Great 

Vein, coming from the 
head and arms to the 
right Auricle. 

10. The ascending Great 

Vein, from the body and 
lower limbs. 

11. Apex of the Heart. 

12. 13, 12, 12. Pulmonary- 

veins coming from both 
lungs to the left Auri- 
cle. 



13, 14. Arteries supplying the substance of the Heart itself. 

The heart has four cavities; two to receive the blood, and 
two, much stronger, to propel it. 



OUTLINE OP ANATOMY. 87 

The blood collected from the capillaries in all parts of the 
lungs, flows onward toward the heart, through vessels which 
are continually uniting and forming larger trunks, until they 
are finally gathered into four great veins that pour their con- 
tents into the first cavity of the heart, called the left auricle. 
As soon as it is full, this auricle contracts and expels it into 
the second cavity or left ventricle. The walls of this cavity 
are prodigiously thick and powerful, for they are designed to 
urge onward the whole mass of the circulating fluid destined 
for the nourishment of all the organs of the body. This ca- 
vity communicates with only one blood vessel, the aorta or 
great artery — into which its contraction forces the blood at 
each pulsation of the heart. 

The aorta bends in a great curve from the top of the heart 
to the spine, and gives off several very large branches in its 
course that pass upward to the arms, neck, and head. It then 
descends on the left side of the bodies of the vertebras, behind 
the bowels, until it reaches the neighbourhood of the pelvis, 
where it divides into two great branches, one of which passes 
to each of the inferior extremities. In the cavity of the chest 
it supplies the lungs with small branches for their sustenance, 
but these little arteries are not at all interested in the respira- 
tory function, of which we shall presently speak. 

The substance of the heart and the coats of the great vessels, 
even the aorta itself are furnished with similar branches, upon 
which they depend for their nutrition. 

In the belly, the aorta gives out many arteries, one or more 
of which reaches every particular organ in that cavity, and 
others are distributed through its walls. 

These great branches go on continually dividing and redi- 
viding, until they become capillary and extend to every part 
of the body. So numerous and universal are these minute 
ramifications that some of the older anatomists believed that 
the human frame consisted entirely of blood vessels; and a few 
writers of a more modern school uphold opinions somewhat 
similar. It is in these ultimate branches of the great arterial 
tree, that the blood undergoes the change in colour that dis- 
tinguishes the contents of the veins, and it is here also that 
the particles necessary for the growth and nourishment of the 
solid organs are separated from the circulation. 

The blood of the capillaries from all parts of the body, sup- 
plied by the aorta and its branches, returns toward the heart 
through the veins. These bloodvessels bear less resemblance 
to the branches or roots of a tree than does the arterial system, 
for they are connected together more frequently by interme- 
diate vessels, so that they form a kind of net-work with large 
meshes, as we may perceive on the back of the hand. As 



88 OUTLINE OF ANATOMY. 

they approach the heart, they are gradually merged into larger 
trunks, which generally accompany the great arteries, and at 
last they are all collected into two only: — one descending 
from the head and superior extremities, the other ascending 
from the lower extremities and pelvis. These are called the 
venae caves, and they meet at an angle at the heart where they 
are united end to end. By means of a large opening at the 
side of the junction of these veins, opposite the angle, they 
pour their contents into the upper cavity on the right side of 
the heart, or the right auricle; this, when full, contracts and 
forces the blood into the lower cavity of the right side of the 
heart, or right ventricle, which is much thicker and stronger 
than the auricle. 

By the contraction of the right ventricle, the blood is urged 
through the pulmonary artery and its branches into every 
part of the lungs. In the capillaries of the lungs, the blood 
is subjected to the action of the air. It parts with its carbon, 
assumes the bright arterial hue, and is rendered fit to renew 
its course in the circulation, and it is then returned to the left 
side of the heart through the pulmonary veins, in the manner 
described at the commencement of this sketch. 

The reader will perceive that the whole left side of the 
heart, together with the veins that enter it and the artery that 
leaves it, are designed to receive and transmit red or florid 
blood, while the blood vessels and cavities belonging to the 
right side of the heart contain only the dark, or, as it is gene- 
rally miscalled, the venous blood. Thus we have a complete 
circulatory system, one half devoted to the functions of nutri- 
tion and secretion, the other to that of respiration. The op- 
posite sides of the heart differ so much in sensibility that nei- 
ther can tolerate the presence of the fluid proper to the other. 
When the respiration is arrested by disease or suffocation, the 
blood cannot part with its carbon, but passes into the left au- 
ricle and ventricle unchanged, and the heart soon ceases to 
act. 

Each auricle, with its corresponding ventricle, stands then 
in the centre cf a long canal with countless ramifications, some 
tending toward it like the roots toward the trunk, and others 
passing from it like the branches from the trunk of a tree. 
There are, therefore, two hearts in reality, but in man they 
are united together and enclosed in one sack; in some animals 
they are widely separate. We might carry out our compari- 
son and liken the whole circulation to two trees standing side 
by side, with their twigs and radical fibres intermingled and 
united at their extremities. 

The human circulation is therefore single; but the 
tion of the two hearts into one, has induced anatomists to do- 



OUTLINE OF ANATOMY. 89 

scribe it as double. They take the veins of the left and the 
arteries of the right side together, and call them the pulmona- 
ry circulatory apparatus, while the arteries of the left, and 
the veins of the right, are styled the general circulatory ap- 
paratus. The distinction is too arbitrary, and leads to con- 
fusion, for neither of these divisions effect a true circulation 
without the aid of the other. 

Before leaving this subject, two important local modifica- 
tions must be noticed; the portal vessels and the capillaries. 



OF THE PORTAL VESSELS. 

The blood distributed by the branches of the aorta to the 
bowels in the abdomen, does not return from the capillaries 
into the corresponding veins like that furnished to other parts 
of the body, but is collected into an independent set of ves- 
sels formed like the veins, but without valves. These vessels 
are gradually collected into a great trunk called the portal 
vein, which passes into the liver and there distributes its 
branches, like an artery, to all parts of the gland. It is the 
dark venous blood of this vessel that furnishes the bile, the 
proper secretion of the liver, the uses of which have been al- 
ready noticed. After the hepatic capillaries have thus accom- 
plished their purpose they then pour their contents into the 
proper veins of the liver, to be carried into the vena cava, 
where they are mingled with the general mass of the circu- 
lating fluids. 

The portal system, or, as it has been sometimes erroneously 
called, the portal circle, resembles another tree with its roots 
and branches, sitting like a parasite upon the nutritious and 
respiratory system, and destined to effect one isolated, but all- 
important secretion. This tree has no heart appended to it, 
and as it commences and terminates in most minute ramifica- 
tions, the motion of its fluids must be laborious and difficult, 
depending very much upon the force of the right side of the 
heart, which continually drives more blood into its radical 
capillaries, and the alternate pressure of the abdominal mus- 
cles and diaphragm which squeezes its contents into the liver. 

Now if any cause should drive the blood from the surface 
of the body toward the deeper seated parts, it is evident that 
the weakness of this system would cause it to yield readily to 
the distention, and this fact assists in explaining many symp- 
toms of congestive fever. Let us take the case of common in- 
termittent. During the chill, there is an irritation of the 
bowels which calls the blood strongly toward them. The 
nerves take the alarm and cause the capillaries of the surface 

12 



90 OUTLINE OF ANATOMY. 

to contract, the patient becomes pale and cold and the blood 
rushes inward. The heart, bowels, lungs, and brain, become 
oppressed with blood. But, most of all, the portal vessels 
often become enormously distended, and the current of their 
blood is embarrassed. The liver, and more especially, the 
spleen, swell to a great extent, and the bowels being prevented 
from evacuating their over-loaded vessels into the portal veins, 
cannot properly exercise their functions. If this slate of things 
were to prove severe and long continued the patient would 
die, but the heart soon commences with the tremendous effort 
to urge the blood onward and equalise the circulation. This 
produces the fever, and the obstacles to the flow of blood in 
most parts of the body are overcome; in some places it may 
prove too rapid, the symptoms of the chill are reversed; the 
stupor of the brain is succeeded, perhaps, by delirium, or the 
engorgement of the lungs gives place to inflammation; but the 
portal vessels are not strong enough to act with corresponding 
energy, and, although the current recommences its flow, more 
blood is still received than can pass on with- facility. The 
liver and spleen continue swelled, the bowels are disordered 
and the secretion of bile vitiated, until the paroxysm passes off. 
Even then, these organs may be left in more weakened con- 
dition than any other parts. If this attack is often repeated, 
the bowels lose their power, the bile remains constantly de- 
fective, the liver and spleen become permanently enlarged, 
and ague cakes, costiveness, dyspepsia, and nervous debility, 
may render the sufferer miserable to the end of his days. 

This short and very imperfect pathological notice is intro- 
duced thus out of place, to keep awake the attention of the 
reader, and to show the absolute necessity of a knowledge of 
anatomy, in order to qualify a man to judge of disease and its 
treatment. 

The Spleen is a very large organ lying on the left side of 
the spine at the back part of the abdomen. It resembles a 
gland, but furnishes no secretion. It is composed almost en- 
tirely of blood vessels, (see fig. 17.) and its only known use 
is to act as a reservoir for the surplus blood of the portal 
vessels when any diseased or healthy action determines the 
blood toward the bowels in unusual quantity. 



OUTLINE OF ANATOMY. 
Fig. 17. 



91 




RAMIFICATIONS OF THE SPLENIC ARTERr IN THE SJPLEEN. 



OF THE CAPILLARIES. 



When an artery divides into two branches, it is generally 
found, that the dimension of the branches, taken collectively, 
is greater than that of the parent stem; and as all the arteries 
are divided a great many times before they become capillary, 
it follows that the caliber of these small vessels must greatly 
exceed that of the trunk of the vascular tree to which they 
belong, and this is true with regard to the veins as well as 
the arteries. Each great division of the circulatory apparatus 
is therefore compared to a cone, the capillaries forming the 



92 OUTLINE OF ANATOMTr 

base, and the principal trunk, where it joins the heart, the 
apex. Now as the heart propels a given amount of blood at 
each pulsation, it follows from this arrangement, that the cir- 
culation becomes very slow by the time it reaches the capilla- 
ries, and that plenty of time is thus allowed, for the separa- 
tion of the different secretions and the deposition of the va- 
rious solids, as the blood passes through these remote conduits. 
Indeed, the smallest visible capillaries in some animals admit 
but one globule of blood at a time, so that every particle comes 
within the influence of that vital power, whatever it may be, 
which rules over the functions of the several organs. 

The capillaries are not simply continued from the arteries 
into the veins, but divide and reunite in every direction until 
they are formed into a complete and very close net work, so 
that if one branch be clogged or broken, the blood flows on 
through other channels; and, unless the injury is very exten- 
sive, no embarrassment of function occurs. 

The coats of these minute vessels are so thin that their 
structure cannot be examined. It is only inferred from obser- 
vations on larger arteries. One thing, however, is certain, they 
may contract or they may yield to dilatation to an astonishing 
extent. The former power is beautifully proved by the pheno- 
mena of a chill — when we see a fine florid complexion instant- 
ly reduced to the extreme of pallor without the loss of a drop 
of blood. The latter is rendered equally striking, when the 
enunciation of a name, or word, calls up the tell-tale blood in 
torrents to the brow of beauty. By this power the capillaries 
can increase both the amount and the rapidity of circulation 
in their canals, when any unusual accident demands a concen- 
tration of vital power in any particular spot. 

There are several functions more or less connected with the 
circulation, which demand a passing notice here. 



OF THE FUNCTION OF NUTRITION. 

The manner in which the chyle is formed from the food 
and conveyed into the veins by the lacteals, has been described 
in the previous section. It enters the right side of the heart, 
mingled with the blood of the vena cava, from whence it fol- 
lows the current into the lungs, and is there converted by an 
unknown process into genuine blood, and forms part of the 
mass of circulation. Many ingenious theories have been of- 
fered to explain the manner in which the capillaries deposite 
the particles that nourish the different organs of the body, but 
it would be worse than useless to discuss them here. All that 
is positively known upon the subject is, that no opening 



OUTLINE OP ANATOMY. 



93 



terminal mouths can be discovered through which these par- 
ticles can escape from the vessels. It is probable that they 
penetrate the coats of the vessels, or rather that they are con- 
veyed through them by some inherent power of the cellular 
tissue; for many substances are actually conveyed through such 
membranes after death, where no openings can exist for the 
purpose. In the complex animals the presence of the nerves 
appears to be necessary to the due performance of nutrition, 
and to the selection of the proper materials for each particular 
organ. 

OF THE FUNCTION OF ABSORPTION. 



Fig. 18. 




a, a, a, a. Lymphatic vessels proceeding to- 
ward the thoracic duct. 
b, b. Lymphatic glands. 



The lymphatics are very small ves- 
sels, somewhat like veins in structure, 
conveying toward the heart a colour- 
less transparent fluid, taken up by their 
mouths or capillary branches from all 
parts of the body. These vessels ap- 
pear knotty from the immense number 
of valves with which they are provided. 
They divide and reunite again in the 
most irregular manner in their course 
toward the blood vessels. 

The absorbent system is furnished 
with very numerous glands. Those of 
the lacteals have been already noticed, 
and those of the lymphatics are similar 
in structure. It is supposed that every 
drop of absorbent matter passes through 
at least one of these glands before it 
reaches the circulation, and that it there 
undergoes some change of structure to 
prepare it for mingling with the blood. 
When, as it is thought sometimes to 
happen, any foreign or deleterious mat- 
ter is taken up by the absorbents, the 
gland or glands to which it \8 conveyed 
are supposed to arrest its progress by 
taking on inflammation, and thus em- 
barrass the flow of the lymph until 
the foreign matter loses its dangerous 
character, or until the gland swells, suppurates, bursts, and 



LYMPHATICS. 



94 OUTLINE OF ANATOMY. 

discharges it from the system. The lymphatic glands, u. 
fore, have been called the sentinels of the circulation. They 
are very irregular in their disposition, but are commonly as- 
sociated in greater numbers about the bends of the principal 
joints, under and above the collar bone, and about the neck. 

' In the simple animals, it is certain that the general cellular 
tissue enjoys the power of absorption, nor is it likely that this 
tissue loses any of its proper functions in man. There is 
strong reason to believe that the skin, the mucous membranes, 
and free cellular membrane absorb certain substances with fa- 
cility, but in man there are numerous vessels expressly de- 
signed for a similar operation on a larger scale. They are 
called the absorbent vessels. They are present in almost all 
parts of the body, and are arbitrarily divided into two classes, 
the lacteals, (fig. 18.) which have been already described, and 
the lymphatics, which differ from the former only in the na- 
ture of their contents. 

We often see the course of the absorbents rendered very 
obvious in a peculiar state of inflammation following slight 
punctures with pins, nails, &c, or the bites of small animals, 
such as rats, mice, squirrels, &c. 

Such cases are very common when there is prevalent an 
epidemic tendency to erysipelas. The wound becomes very 
painful and wears a threatening appearance; red lines are soon 
observed running along the limb, and when closely examined 
we feel that they are caused by as many small hard cords, run 
ning along beneath the skin, and extremely painful when 
touched. These cords are inflamed absorbents, and their ap- 
pearance has led to the popular, but mistaken notion, that 
something poisonous is conveyed into the wound by the instru- 
ments above named. The symptoms result entirely from the 
well-known tendency of inflammation to run along the sur- 
face of any organ that it attacks until it is arrested by some 
barrier formed by a substance of a different structure and vi- 
tal action. This barrier, in the case of the absorbents, is 
formed by the glands. The inflammation generally advances 
till it reaches a large joint, where it may be quietly arrested, 
or, if the glands themselves inflame, the flow of lymph may 
still be checked, the absorbents above the joint may be pro- 
tected and the glands may suppurate and form a troublesome 
abscess. If, however, the inflammation passes the first joint, 
it generally continues in full vigour to the next, and so on, 
until in some cases it reaches the body, and the patient's life 
is then in the most imminent danger, either from the extension 
of the disease to the blood vessels, or from the exhaustion pro- 
duced by an immense abscess on the side. Several most dis- 
tinguished professors of anatomy have lost their lives in thi^ 



OUTLINE OP ANATOMY. 95 

manner from slight wounds received from the knife in dissect- 
ing dead bodies. 

If poisons are actually taken up by the absorbents, they 
rarely display their effects on these vessels themselves, but 
they may produce symptoms in the glands analagous to those 
just described. Some poisons, like those of venomous snakes, 
force their way into the circulation with rapidity, in spite of 
all the guards, while others reach it very slowly, like those of 
hydrophobic animals, if indeed there is really any virus pre- 
sent in such animals; a question that is not positively settled, 
however probable it may appear. The phenomena that are 
produced by the bite of the rattlesnake and viper seem to 
show that their poison is received directly into the blood ves- 
sels without the intervention of the absorbents, and the same 
is probably the case with most active poisons. 

The strongest proof of the guardianship of the absorbent 
glands, is the milder inflammation generally observed in those 
that are seated in the immediate neighbourhood of cancer, and 
many diseases of the skin; but the whole subject of absorption 
is still involved in doubt, and the only fact absolutely ascer- 
tained is the occasional introduction into the circulation of 
matter foreign to the blood, through the lacteals, the lympha- 
tics, and the veins. 



OF RESPIRATION. 

We have already described the general structure of the tho- 
rax or chest, the cavity principally designed to accommodate 
the organs of respiration. We have spoken of the curves of 
the spine interested in the function of breathing; the form and 
motions of the ribs and intercostal muscles; the position and 
action of the diaphragm or midriff, and the mechanism of in- 
halation and exhalation; but it is necessary, before we con- 
sider the change in the circulating fluids effected by the lungs, 
to add some farther remarks upon the most essential parts con- 
cerned in the act of breathing. 



APPARATUS OF RESPIRATION. 

Between the root of the tongue and the upper extremity of 
the gullet, we find the opening into the canal which conveys 
the air into the lungs. 

The upper portion of this canal is called the larynx. It 
forms the hard tumour which we feel when we grasp the upper 
part of the throat with the fingers; and its most prominent 



96 



OUTLINE OF ANATOMY. 



part — much more elevated in the male than in the female — is 
commonly called Adam's apple. 

Fig. 19. 




Fig. 20. 




GLOTTIS, OR TRACHEA. 

1, 1. Thyroid cartilage. 

2, 2. Greater horns of cartilage. 

3, 3. The vocal cords, or ligaments 

of the orifice of the glottis. 
4. Orifice of the glottis. 
5, 5. Arytenoid cartilages, moveable 
by muscles, and assisting in 
regulating the voice. 
6. Cricoid cartilage. 



LARYNX SEEN EXTERXALLT. 



1. The os hyoides, or bone of the root of the tongue. 

2. One of the little horns of this bone. 

3. One of the great horns. 

4. The epiglottis, or cartilage which closes the windpipe in swallowing. 

5. Membrane connecting the os hyoides with the thyroid cartilage. 

6. Thyroid cartilage, or cartilage of Adam's apple. 

7. Cricoid cartilage, forming the base of the larynx. 

8. Part of the windpipe, or trachea. 



The larynx is the organ of the voice. It is chiefly com- 
posed of five very singular cartilages, covered by nervous 
membrane, which enclose a large space every where but at 
their upper end, where the membrane is folded upon itself in 



OUTLINE OP ANATOMY. 97 

such a way as to resemble a valve, leaving a very narrow 
chink for the passage of the air. 

The two smallest of these cartilages are connected by move- 
able joints to the lowest of the series. They are placed very 
near each other, at the posterior end of the chink just men- 
tioned; and two well defined ligaments or cords pass forward 
from their base to the most prominent part of the larjaix, with- 
in the folds of the membrane that forms the valve or partition, 
keeping those folds upon the stretch, and thus determining 
the size of the orifice. Many small and very delicate mus- 
cles are connected with these cartilages, and their various ac- 
tions render the cords just mentioned either tighter or looser, 
so as to change the size of the opening, and consequently the 
pitch and body of the voice. 

One of the most curious of these cartilages, is placed just 
behind the root of the tongue, where it may be seen in some 
persons by looking into the mouth. Its shape is like that of 
a leaf standing upright upon its stem. The broad surface an- 
swering to the upper side of the leaf is directed backward to- 
ward the spine, the back of the leaf toward the mouth, and 
the stem is united below to the large cartilage which forms 
the prominence or apple of the throat. This leaf rises high 
over the orifice of the larynx, and when we eat or drink it is 
drawn down over the opening so as to allow the food to slide 
safely into the gullet. When this cartilage acts imperfectly, 
either from accident or disease, nature still secures the air pas- 
sages from being entered by the food; for the moment any 
thing touches the orifice of the larynx, it is spasmodically 
closed by its muscles, and a cough almost instantly blows 
away the offending substance. Nevertheless, small substances, 
such as coins, cherry stones, &c, do sometimes enter the tra- 
chea, and it is a curious fact, that the moment they fairly pass 
the orifice, the spasm ceases, because the continued stoppage 
of the passage can no longer protect the lungs. 

Below the larynx the air passage takes the name of the tra- 
chea or windpipe. It is here composed of narrow strips of 
flattened cartilages, like hoops — that enclose two-thirds of its 
circumference or more, and are placed almost in contact with 
each other. The tube is completed by a strong, tough, elas- 
tic membrane, that continues from ring to ring along the whole 
length of the windpipe, and fills up the space behind, where 
the cartilages are deficient. 

The inner surface of the rings, and their connecting mem- 
brane, is lined by many fibres of a muscular appearance, run- 
ning in different directions in different places. As little is 
known of their use, I shall merely mention them. 

The mucous membrane lining the mouth, nose, and gullet 

13 



98 OUTLINE OF ANATOMY. 

is continued into the orifice of the trachea, and lines the air 
passages throughout their whole extent. It is here much 
smoother than in the alimentary canal, and is deprived of the 
folds that are seen in the intestines. It soon becomes extreme- 
ly thin and delicate. 

The windpipe enters the chest and continues to descend 
near the spine until it reaches the third vertebra of the back, 
where it divides into two great branches, called the bronchia?, 
one of which passes to the right, the other to the left side. 

The great blood vessels and nerves going to and from the 
lungs are associated with these branches, so as to form with 
them two considerable masses, which are called the roots of 
the right and left lung. 

The bronchia? are formed in the same manner with the 
trachea or windpipe; but as soon as they enter the lungs, they 
go on continually dividing and becoming smaller and thinner, 
till their very minute ultimate ramifications reach every part 
of those organs. Their cartilages are less regularly arranged, 
and after the first divisions of these tubes have taken place, 
they surround the whole circumferance of the canal. The 
connecting membrane becomes more and more elastic as it ad- 
vances, and the mucous coat is at last so extremely attenu- 
ated that it is scarcely visible. 

Throughout their whole course the bronchia? are attended 
by the blood vessels, and both at length become capillary. 

At their termination the bronchial ramifications open into 
the air cells of the lungs, which are little membranous sacks, 
so small as to be almost invisible, and their coats too thin for 
a close examination. These cells compose nearly the whole 
substance of the lungs, and the ultimate capillary blood ves- 
sels are every where ramified over their surface, thus bring- 
ing the blood almost into contact with the air that they con- 
tain. 

Between the air cells there is a little common cellular tis- 
sue, which connects them together, and forms what is called 
the substance of the lungs. It is the seat of pneumonia or in- 
flammation of the lungs, a disease that differs very widely 
from inflammations of the outer surface of the organ, and also 
from those of the lining membrane of the bronchia?. There 
are also numerous small glandular bodies called bronchial 
glands, of which the use is imperfectly known; they are ge- 
nerally found near the tubes from which they take their name. 
The substance of the lungs is nourished by small blood vessels 
arising from the intercostal or other vessels belonging to the 
arterial tree of the left side of the heart, and thus the arteries 
of the right or pulmonary side are left free to perform the sin- 



OUTLINE OF ANATOMY. 



gle function of respiration without being embarrassed with 
the duties of nutrition. 

The lungs, then, are composed, first, of an air-tube with 
very numerous ramifications, communicating with the atmo- 
sphere, and kept always open by its cartilaginous rings; se- 
condly, of air cells for the reception of the atmosphere when 
inhaled, communicating freely with the air-tube; thirdly, of 
cellular membrane, interposed between all the various parts; 
fourthly, of two distinct sets of arteries and veins; one for the 
nourishment of the organs, derived from the left side of the 
heart; the other, for effecting the change in the nature of the 
blood that takes place in respiration, and derived from the 
right side of the heart. Besides these more bulky parts, 
there are the bronchial glands, the nerves and the absorbents. 

The lungs, together with the heart and great vessels fill 
nearly the whole cavity of the chest. When removed from 
the body, and inflated by air blown into the windpipe, they 
resemble in form the hoof of an ox, with the hinder part pre- 
senting forward. When we examine them particularly, we 
see that they are divided into two separate organs of the same 
nature, connected together by the first great branches of the 
windpipe; the right organ being partially subdivided into 
three lobes, and the left, which is smaller, into two. The heart, 
with its investing sac, lies in the middle space between the 
two lungs in front, and the great vessels, the gullet, &c, pass 
through the same space behind, so that the lungs are not in 
contact with each other over the greater part of their prox- 
imate surfaces. 

Fig. 21. 



a. The heart and great 
vessels. 

b, b. The right and left 

lungs. 

c, c. The diaphragm. 



Each lung is en- 
veloped in its own 
proper serous mem- 
brane, which covers 
every part of its sur- 
face, and is reflected 
from its root, in a 




THE VISCERA OF THE CHEST. 



broad expansion that 
stretches backward to the spine, and forward to the breast 
bone, downward to the diaphragm, and upward to the edge 
of the first rib. From these attachments it is continued over 



100 OUTLINE OF ANATOMY. 

all the surface of the side of the chest, so as to form a com- 
plete sac like the peritoneum, every where in contact with 
itself, but so smooth and moist as to prevent all friction. 
These two serous membranes are called the pleurae, their 
inflammations are well known under the title of pleurisies. 

Each pleura forms, then, a separate cavity, entirely cut off 
from air or any other fluid than its own secretion, and the 
two together divide the chest down the middle by a kind of 
double partition; and, as the heart, closed in the pericardium, 
lies between the two walls of this partition, the cavity of the 
chest is divided into three great chambers having no commu- 
nication with each other; one for the heart and one for each 
lung. 

OF THE FUNCTION OF RESPIRATION. 

When blood is drawn from a vein, it is at first of a dark 
purple colour, but after it has been for a short time exposed 
to the external air, it becomes considerably brighter and re- 
sembles blood drawn from an artery. This proves that the 
atmosphere acts chemically upon the fluids of circulation when 
removed from the body. Again, actual contact is not neces- 
sary to the production of this change, for it takes place when 
the blood is enclosed in a thin bladder, and suspended in a 
draft of air. Now it is by no means certain, that the altered 
character of the blood, in this experiment, is precisely the 
same with that known to be effected in the lungs of a healthy 
man, because a similar change of colour is produced by some 
other gases besides atmospheric air and its several i 
dients; yet the change sufficiently proves that chemical a. 
may act on the contents of a vessel, through its coats, and 
thus removes the difficulty of accounting for the alteration of 
the blood in the vessels of the lungs, under the influence of a 
portion of air which does not come into direct contact with it. 

The blood enters the lungs, charged with a great amount of 
carbon, which must be removed in order to fit it for the func- 
tion of nutrition. The air drawn into the air cells, is com- 
posed of two ingredients, the one, called vital air or oxygen, 
a gas too stimulating to be breathed with impunity, when pure; 
the other, called nitrogen, a gas that produces no effect on life, 
and is merely useful, by diluting the vital air until it is weak 
enough to be tolerated by the delicate structure of the lungs. 
Now it is found that when the air is expelled by the lno| 
is no longer composed simply of oxygen and nitrogen; a con- 
siderable portion of the former gas is no longer seen, and in 
its place we find an equal bulk of fixed air or carbonic acid 
gas, formed by the union of the carbon of the blood with the 



OUTLINE OF ANATOMY. 101 

oxygen of the atmosphere. So great is the quantity of this 
fixed air given off by various animals in respiring, that, long 
ago, it would have rendered the whole atmosphere unfit for 
healthy existence, were it not for a most wise provision of 
nature, that this poison thrown out by animals, should be em- 
ployed as nutriment by vegetables. Plants absorb the surplus 
carbonic acid of the atmosphere, and thus contribute to pre- 
serve its purity. 

So great a degree of condensation takes place when carbon 
and oxygen unite to form carbonic acid gas, that the bulk of 
the product is precisely the same with that of the aerial ingre- 
dient, or in other words, the whole amount of carbon is dis- 
solved without increasing the bulk of the oxygen with which 
it combines. It is well known that heat is always given out 
when the chemical union of two bodies is attended by con- 
densation, and such is evidently the case here, yet we do not 
find the heat of the lungs greater than that of other deep- 
seated parts of the body: what then becomes of the caloric 
eliminated in respiration? 

We owe the happiest solution of this query to Mr. Craw- 
ford, who found that the capacity for heat was greater in ar- 
terial than in venous blood. The surplus heat given out by 
the oxygen in uniting with the carbon, is therefore instantly 
absorbed and concealed by the altered circulatory fluid; it 
travels with it to the left side of the heart, from whence it is 
distributed to all the nutritive capillaries of the body, and as 
the blood undergoes the changes in these vessels, that reduce 
it again to the venous character, its capacity for caloric, is 
there gradually diminished, and the surplus heat is thus dif- 
fused so as to produce that equality of temperature observed 
throughout the body when in health. This theory is so sim- 
ple and so beautiful that it would be almost a pity to overturn 
it, but it is not considered as fully established. 

The action of the lungs, is not entirely confined to the eli- 
mination of the carbon of the blood, and the absorption of ani- 
mal heat; it likewise contributes in no small degree to the re- 
moval of the surplus water of the circulatory fluids, for the 
air enters the lungs when nearly dry, but it always returns 
loaded with moisture. In this respect it resembles the skin 
in function, and may be said to aid in effecting a kind of per- 
spiration. 

Respiration, like all the other animal functions, is not abso- 
lutely confined to the lungs in man, the gills in fishes, or the 
branchiae in insects; for the simple animals that are not pro- 
vided with a vascular circulation, or with any of the organs 
just mentioned, evidently respire by the surface of the body, 



102 OUTLINE OF ANATOMY. 

the only part brought into contact with a fluid containing oxy- 
gen. It is equally certain that man also respires by the skin, 
for not only is that superficial membrane constantly pouring 
out vapour in the form of sensible or insensible perspiration, 
but carbonic acid gas is also found escaping from it in the 
same manner, without intermission. The complexity of the 
human frame, however, renders it impossible for the skin 
alone to free the whole amount of blood from its excess of 
carbon, and the peculiar apparatus of respiration is therefore 
superadded to complete the process. Still, it is well to re- 
member that the lungs and the skin are designed to aid each 
other reciprocally, hence, want of cleanliness, continued ex- 
posure to cold or damp air, improper clothing, and all other 
causes that tend to disturb the functions of the latter and to 
check the escape of perspiration, necessarily compel the lungs 
to perform double duty; they are therefore seriously oppressed 
by such causes, and these are indeed the foundation of many 
diseases of the lungs. 

When any of the cavities of the body are ex-posed, or when 
air is admitted into the common cellular tissue by a wound, 
the same changes in the blood of the neighbouring vessels 
takes place to a greater or less extent, or, in other words, we 
respire by the injured surfaces. This occasions an increased 
vital activity in the part, and is probably the cause why air 
has been considered so powerful a stimulant by some writers. 
The irritating qualities of air have been vastly exaggerated, 
but the effect just noticed is actually produced, and it is there- 
fore very well to exclude it from places where nature never 
designed it to enter. 



OF SECRETIONS. 

We have already spoken of most of the very important se- 
cretions under the foregoing heads. In treating on Digestion, 
we mentioned the saliva, the pancreatic liquor, the bile, and 
the intestinal mucus; under the head of respiration we spoke 
of the disengagement of carbon and water from the lungs and 
skin, and of animal heat from the general capillaries; all of 
which products may be regarded as secretions. 

Secretion, then, is the separation of certain substances from 
the circulatory fluids by the capillary blood vessels. It takes 
place in the interior of every organ, producing its growth and 
renovation. It is seen on the external surface producing per- 
spiration, on the internal surface in the form of mucus, and in 
the lungs, effecting the separation of carbon and moisture from 



OUTLINE OF ANATOMY. 103 

the blood. In the secretory glands, it elaborates fluids that 
are generally rendered useful in some way or other before 
they are ejected from the body. 

There yet remains one of the most important secretions, of 
which it is necessary to take some notice. I allude to the 
urine. 



OF THE URINARY APPARATUS. 

The kidneys are two large glands destined to secrete the 
urine. They are placed, one on each side of the spine, behind 
the peritoneum, and opposite the two lower vertebrae of the 
back and the two upper ones of the loins. The right kidney 
is placed a little lower down than the left, to allow more am- 
ple room to the liver, which is nearly in contact with it. These 
organs, therefore, cannot be regarded as part of the contents 
of the abdomen, and they have no connexion with the portal 
blood vessels. 

The form of the kidneys is too well known to require any 
description; for those of the ox and the sheep, which are fre- 
quently seen on the table of such as are not too fastidious in 
their taste, convey an idea sufficiently accurate for the non- 
medical inquirer. 

The outer part of the kidney is so full of minute blood ves- 
sels that when these are injected with wax, and the animal mat- 
ter removed from around them by air and acid, they preserve 
the general form of the organ, and present us with one of the 
most beautiful anatomical preparations that can be imagined, 
so much so, indeed, that it is not unusually employed as a 
mantel ornament by anatomists! 

On the inside of this vascular shell of the kidney we may 
observe a paler substance, formed into a number of little nip- 
ple-like eminences, all pointing toward the great fissure in the 
middle and inner side of the gland. These eminences are 
chiefly composed of very small vessels, or rather ducts, which 
are arranged side by side in great numbers, and are designed 
to convey the urine from the capillaries as it is formed. Each 
nipple is generally enclosed in a separate membranous funnel 
which receives the urine from the ducts, collects it, and then 
pours it into a large membranous sac called the pelvis of the 
kidney. 






104 



OUTLINE OF ANATOMY. 



Fig. 22. a, a. Cortical substance. 

b, b. The tubular portion, 
c, c, c, c. The papillae. 

d. The pelvis of the kidney. 

e. The ureter, or duct, carrying 
the urine to the bladder. 



The pelvis of the kidney is 
the common receptacle of the 
urine from all the eminences 
above described. It occupies the 
greater part of the fissure of the 
kidney, and from the side next 
the spine it sends out a long ca- 
nal or duct called the ureter, 
which passes along behind the 
peritoneum into the pelvis, where 
it enters the bladder at its lower 
part The urine flowing con- 
stantly and without intermission 
from the kidneys, through the 
ureters into the bladder, collects 
in this great reservoir until it is 
convenient to evacuate it. The loss of this control over the 
flow of the urine, which sometimes results from surgical in- 
juries or disease, is one of the greatest evils that can befall hu- 
manity. 




SECTION OF KIDXEY. 



The bladder, when empty, occupies very 



little 



:pace. 



and 



lies entirely within the pelvis; but when distended with urine, 
it rises high into the abdomen, always in front of the bowels, 
which it thrusts out of the way until in extreme cases it has 
been known to rise even to the pit of the stomach. 

The structure of the bladder resembles that of the hollow 
bowels so fully described above. It has the internal mucous 
coat,— but without valves or obvious villosity; — the condensed 
cellular coat; and the external muscular coat, — over which we 
find the peritoneum covering the upper end, a small portion 
of the front, and somewhat more of the posterior side of the 
bladder; but the extent to which this viscus is covered by the 
peritoneum depends mainly on the degree of its distention at 
the moment. The lower part of the bladder is always free 
from such investment. 

One of the strongest peculiarities of the bladder is the close 
proximity of the three canals; the two ureters bringing the urine 
to the reservoir, and the urethra conveying it to the surface: 
their openings form a small triangle at the lowest part of the 
organ. 



OUTLINE OF ANATOMY 



105 



Fig. 23. 



K, 


K. 


L 


L. 


M, 


ML 




N. 




O. 


Q 


Q. 




R. 




S. 


u, 


u. 




V. 




X. 



A, A. The concave surface of the 
liver turned up. 

B. A small posterior lobe of the 

liver. 

C. The cleft where the portal 

vein reaches the liver, 
E, F. The gall bladder. 

G. The pancreas or salivary gland 
of the abdomen, lying across 
the spine. 
H. The spleen. 
I. The ribs. 
The kidneys. 
Renal veins. 
Ureters, or ducts, leading from 

the kidneys to the bladder. 
Aorta, or artery of the body. 
Spermatic arteries. 
Common iliac arteries. 
Vena cava, or great vein of the 

body. 
Spermatic vein of the right side. 
Common iliac veins. 
The end of the colon, tied. 
Commencement of the rec- 
tum. 
Y, y. Urinary bladder. 



The Urethra is the membra- 
nous canal that conveys the 
urine from the bladder when 
viscera, of the AiiiwMEN ajtd pelvis— evacuated. It is the seat of se- 

THE STOMACH AND BOWELS BEING RE- 1 •» f..l J* ^„„ 1. i. •* • 

MOYED# veral painful diseases, but it is 

not consistent with our present 
purpose to mention them here. 

The urinary apparatus gives us an excellent idea o( the 
structure and arrangement of the excretory ducts in general. 
At the outer orifice of the urethra, the skin is reverted in- 
ward, but almost as soon as it enters the canal, it assumes all 
the characters of mucous membrane. The cuticle continues 
to cover its surface for some distance, but soon disappears, 
and the mucous membrane advances alone. When it enters 
the bladder, it expands so as to line the whole organ, and then 
proceeds through the little orifices of the ureters, which it fol- 
lows throughout their whole extent On reaching the pelvis 
of the kidney it again expands, lines the whole of those cavi- 
ties, the funnel-shaped sacks, the nipple-like projections, and 
in all probability, the ultimate urinary ducts likewise, though 
the extreme minuteness of the last mentioned canals renders 
their exact structure invisible. Such is the arrangement of 
all the outlets of the body, whether found on the internal or 

14 




I'OS OTTTLIWE OF ANATOMY* 

external surface, whether they open into the bowels or on 
the skin. Properly speaking, there are no such things as pas- 
sages from within the substance of the body; for the intega- 
ments dip into every cavity, and so line and invest it that 
every part is covered either by the skin or mucous membrane, 
or some reflection thereof. When a part is exposed to the 
air it assumes the appearance of true skin, and becomes co- 
vered with cuticle, whereas, if it is protected at all times from 
such exposure, it retains or acquires the character of mucous 
membrane. 



OF THE URINE. 

The Urine, the peculiar fluid secreted by the kidneys, is 
very different in character in different tribes of animals, and in 
various individuals. It even changes its properties in the 
same individual, according to the nature of the diet and the 
time of day, in health — or, according to the peculiar character 
of the attack, in disease. 

It is, however, one of the most important agents in the pu- 
rification of the blood. It removes a very large portion of 
the superfluous water from the circulation, and this is accom- 
plished in so short a time after drinking, that many anatomists 
were formerly deceived into the belief that there existed some 
route by which water could be conveyed from the stomach ta 
the bladder more directly than by passing into the blood. la 
this particular the kidneys seem to aid the functions of the 
skin, and it is well known that when perspiration flows freely 
the quantity of urine is diminished, and generally becomes high 
coloured. On the contrary, when perspiration is checked by 
any means, without fever, the urine is generally more copious 
and watery. 

Urine contains a considerable amount of an animal substance 
peculiar to itself, of which the largest constituent is nitrogen; 
and it is, therefore, thought that the kidneys are designed to 
separate from the blood the surplus of that element, which is 
present in almost all parts of the body, and furnishes one of 
the strongest distinctions between animal and vegetable mat- 
ter in general. Most of the peculiar ingredients of the body 
are occasionally present in the urine, and those which are ca- 
pable of assuming the solid form, are sometimes known to 
crystallize in the urinary passages, giving rise to gravel or 
stone — one of the most painful diseases to which man is sub- 
ject. Sometimes the stone forms in the pelvis of the kidney, 
where it may grow and occasion inflammation and absce- 
it may descend through the ureter, giving rise to most ago- 



outline of anatomy. 107 

mzlng pain in its route. If it reaches the bladder it generally 
remains unnoticed for some time, but as its growth is con- 
tinual, it finally brings on violent irritation, and all the symp- 
toms of the disease termed stone in the bladder. Sometimes 
great numbers of small stones descend the ureters, and from 
their diminutive size, are washed out of the bladder almost as 
rapidly as formed, constituting what is commonly called gra- 
vel. Now and then a piece of gravel unusually large gets 
clogged or arrested in the urethra, or external passage. The 
urine is then entirely checked, and prompt assistance is re- 
quired to save the life of the patient. 

We have now enumerated most of the essential systems 
and organs of the human body, except a few which are not 
fitted to appear in a popular work, and before we proceed to 
mention the connecting bonds which cause this most curious 
apparatus to act cowrectly and without disorder, it only re- 
mains for us to add a few words upon the envelope or mantle, 
which covers and encloses this complex machine, constituting 
at the same time, the general armour of the system and a dis- 
tinct organ for the performance of most important functions. 



OP THE SKIN OR INTEGUMENT. 

Fig. 24. 1 . The cuticle or scarf 

skin. 

2. The rete mucosum, 
or coloured stratum 
of the skin. 

3. The papillae of the 
skin, on the surface 
of the true skin. 

4. The cutis vera or 
true skin. 

5. The subcutaneous 
cellular tissue. 

6. Some fibres of cuta- 

neous muscle. 

The Skin or Integument, as we have already noticed in 
our introductory sketch, is an envelope, enclosing the whole 
surface of the body, composed of condensed cellular tissue, 
with a horny and inorganic surface, which it secretes for its 
own protection. It may be divided into three distinct layers; 
first, the cutis or true skin; that part which may be converted 
into leather by tanning; secondly, the rete mucosum, or mu- 
cous net work; that part which gives the peculiar colour to 
the races and varieties of mankind; and lastly, the cuticle, or 
horny covering, which is insensible, inorganic, and seems like 
a mere dried secretion, designed for the mechanical protection 




gECTlOK or THE SKIJf. 



10S OUTLINE OP ANATOMr. 

of the other layers. This division is carried farther by mo- 
dern anatomists, but it is unnecessary to dwell upon minutia 
in the present work. 

The Cutis Veru i or True Skin. This is a very strong, 
lough membrane, composed of the free cellular tissue which 
forms the general bond of union between the various organs 
of the body, gradually condensed, and strengthened by firmer 
fibres. On its inner surface it is loose in texture, and rough, 
but it soon becomes comparatively hard, without losing its 
flexibility. It is every where covered with little holes or 
rings, filled with softer matter, through which the capillary 
arteries and veins, with the nerves and absorbents of the skin 
pass and repass to the surface of the layer. 

In some places, this layer is very thick and firm, as on the 
palms of the hands and the soles of the feet, while in others it 
is exceedingly thin and delicate, as in the neck and the bend 
of the different large joints. In parts designed by nature to 
sustain repeated shocks, the true skin becomes thickened by 
frequent rough usage, but in those which are protected by 
their situation, pressure is apt to occasion a thinning and ul- 
ceration of the membrane. 

The Rete Mucosum or Mucous Net Work. As soon as 
the nerves and vessels of the skin have passed out through the 
rings or meshes of the cutis, they display themselves on its 
exterior surface. The vessels ramify and communicate with 
each other to a great extent, and their attendant nerves are 
enlarged and softened so as to become acutely sensitive to 
every impression. This arrangement produces a great num- 
ber of little eminences or projections, resembling in some de- 
gree, the villi of the intestines. They are called the papillae, 
and are formed of the naked, soft, and expanded terminations 
of the most minute branches of the nerves of feeling, sur- 
rounded by a multitude of capillaries, twisted, united, and in- 
volved with each other in the most complex manner. 

This arrangement is intended to give the greatest quick- 
ness of sensation to the touch, and wherever great delicacy 
of feeling is required, the papillae are more numerous and 
better defined, as at the point of the fore-finger, the tip of the 
tongue, &c. 

These papillae, or villi, are protected by an extremely deli- 
cate cellular tissue, filled, and surrounded by a kind of mucous 
varnish, from which it takes the name of the rete mucosum, 
or mucous net work. It forms the second, or middle layer of 
the skin, in which is deposited the colouring matter that gives 
variety to the complexion. When this colouring matter is 
entirely absent in the white race, we observe that peculiar 
transparency of the whole surface which marks the albino; 



OtJTLlNE OF ANATOMY. 109 

and it is very remarkable that in such cases the peculiar colour 
of the eye is also wanting, so that the blood vessels of that 
organ, like those of the skin, shine through the surface and 
give the iris a bright red tint, while the hair is rendered 
snowy white, by the same general cause. A deficiency of 
this deposite renders the complexion, the eyes, and hair, light, 
as we observe it in persons of a scrofulous or consumptive 
constitution, and an excess produces, in like manner, the dark 
skin, the black eyes, and hair of the brunette. 

The Cuticle or Scarf Skin, appears to be devoid of anima- 
tion; it contains no blood vessels, no nerves, no cellular tissue, 
but seems to be a mere incrustation on the surface of the rete 
mucosum, by which it is thrown out. We see it elevated in 
blisters, because the inflammation producing them, causes the 
vessels of the skin to secrete a large quantity of serum in 
place of the matter fitted to form cuticle. 

The scarf skin is continually worn off by friction, and is as 
constantly replenished from within. It is divided into little 
squares or lozenges by numerous wrinkles running in various 
directions and crossing each other. It is studded with hairs, 
which are generally found at the intersections of the wrinkles, 
and on the fingers and toes it is armed with nails. 

It is a popular idea, to the truth of which the older physi- 
ologists acceded, that the cuticle was perforated by innume- 
rable holes, called pores, through which the perspiration 
escapes to the surface; but this idea is now proved to rest upon 
no solid foundation. The most minute microscopic investi- 
gations show that there is no breach in the continuity of this 
mantel: even the hairs, though their roots are found deeply 
imbedded in the inner membrane of the skin, do not in reality 
pass through it; for the cuticle is reflected inward around each 
hair until it reaches the bulb, to which it adheres, and then 
returns along the hair, with which it is so completely amalga- 
mated that it is impossible to separate them. 

Pores, then, do not assist in the skin, yet it is certain that 
sensible and insensible perspiration, gases, &c. pass through 
it from within, and it is highly probable that some substances 
enter the system by the same route. This power of transmit- 
ting gases or fluids, is now known to be common to all organ- 
ized membranes, whether animal or vegetable, both during 
the life and after the death of the individual to which they 
belong; thus, if a piece of bladder, in which there exists no 
opening, is tied over the mouth of a bottle of spirits, the water 
of the spirits evaporates and passes through the bladder with 
rapidity, while the more volatile alcohol is retained much 
longer, so that the spirits, in time, become stronger; while, on 
the contrary, if there be no bladder placed over the bottle, 



110 ©XTTLINE OF ANATOKT. 

the alcohol will evaporate and leave most of the water he* 
hind. 

It is not by clogging the pores then, that dirt impedes the 
flow of perspiration and injures the health, but by covering 
the cuticle with a kind of varnish which necessarily impedes 
the, exit of fluids through its substance, in the same manner 
that a coating of resin prevents the passage of water or vapour 
through a bladder. 



OF THE FUNCTIONS OF THE SKIN. 

The general function of the skin is to give form, grace, pli- 
ancy, and afford protection to the surface of the body, as well 
as to prevent the rapid evaporation of animal juices. The spe- 
cial functions of the true skin, are to give support to the deli- 
cate nervous filaments upon which the sense of touch depends, 
and to furnish a secure foundation for the net work of minute 
blood vessels that are distributed upon its outer surface, by 
which the cuticle, nails, hair, and all other appendages are 
formed, and the perspired matter secreted. The cuticle, as 
has been already remarked, presents no appearance of organi- 
zation, and cannot be considered as executing any peculiar 
function; for in transmitting the perspiration, it probably acts 
like any other animal membrane. We shall have occasion to 
speak farther on the subject of the cuticle, under the heads of 
cleanliness and clothing in the chapter on Hygiene. 



OF THE NERVES. 

All animals of complex organization require some medium 
of connexion between their different organs, some established 
government to direct the efforts of the various departments of 
the system toward a common purpose — the growth, health, and 
good order of the whole. This bond is furnished by the 
nerves. 

The Nerves, are small fibres or bundles of fibres passing from 
one part of the body to another. They generally originate 
in one or more masses, called nervous centres, and are distri- 
buted at the other extremity, in minute divisions to all parts 
of the several organs supplied by them. They are so impor- 
tant, and their operations are so little understood, that we 
may be excused for dwelling upon their history at some length. 
If, by so doing, we should succeed hereafter in persuading our 
readers that the long train of human ills usually classed under 
the head of disordered nerves and nervousness are realK 



cOTTT&mE OF iLNATOOT. Ill 

*wf©ng '-the most painful, unmanageable, and serious afflictions 
to which we are subject, if I succeed in eliciting an occa- 
sional sigh of sympathy for sufferings too generally witnessed 
with a smile, or a sneer, the cause of humanity will be served 
and my labour amply rewarded. 

Nervous Matter, or the substance of which the nerves 'is 
formed, is commonly divided into two kinds. 

The one kind is gray, soft, and not very obviously fibrous, 
and is found chiefly at the origin of the particular nerves, al- 
though many anatomists are of opinion, that they are com- 
posed of this kind of substance at both extremities. The 
other kind of nervous matter is white, and is invariably ar- 
ranged in well marked fibres, either separate or collected Ib. 
tbundles. 

When carefully examined by the mi- 
croscope, aided by certain chemical mea- 
sures, both these varieties of matter are 
found to be ultimately composed of small 
globules of a peculiar character united to- 
gether by cellular membrane of extreme 
delicacy. The globules are irregularly 
placed in the gray, but are ranged in rows 
in the white substance; and these rows al- 
ways remain distinct; never mingling or 
becoming confused in their course. Suck 
a -row of nervous globules continued^ 
without interruption, from the gray substanee in which it ori- 
ginates to its termination at the surface or in the substance 
of some organ of the body, constitutes what is called a nerv eus 
Jilament. 

*& Nerve is a cord composed of a number of nervous fila- 
ments formed into a bundle, like a skein of silk after it is cut 
and prepared for the thread-ease. In addition to the very de- 
licate cellular membrane connecting the globules of which the 
filaments are composed, each filament is generally found en- 
veloped in a sheath of stronger cellular tissue, and the whole 
nerve is also provided with a similar covering of still firmer 
character. Small blood vessels are observed to enter the 
nerves, and the ultimate branches are distributed throughout 
the substance of their connecting membrane, in order to nou- 
rish and enable them to maintain their functions. The strength 
of the sheaths surrounding the filaments has induced many 
anatomists to describe the nerves as collections of tubes filled 
with nervous matter, but they are really solids composed of 
the several parts just specified. 

The consistence and colour of Nerves are somewhat diffe- 
rent, in different parts of the system; their functions are equal- 




112 OUTLINE OF ANATOMY, 

Jy various, but the relation between their structure and uses 
is still among the unfathomed mysteries of nature. 

The proper function of the Nerves is best expressed by the 
term sensibility, but this word is not used here in its popular 
acceptation, and we are, therefore, compelled to illustrate, at 
some length, the extension which must be given to it 

Each individual nerve, or corresponding pair of nerves, 
has its own kind of sensibility; thus, those of the eye distin- 
guish light and colours; those of the nose, odours; those of the 
ear, sounds; some of those of the tongue, flavours; those of the 
surface, touch; and thus far all is perfectly intelligible. Hut 
there are other nerves whose powers bear little or no ro 
blance to what is commonly called sensation. Hunger, thirst, 
and some other obscure feelings perceived by the nerv 
the stomach or bowels, are indeed, in some nalagous 

to the five external senses; and, by using the word sensation 
metaphysically, we may apply it to the feeling of anger, affec- 
tion, and many other instincts, each of which has its appro- 
priate set of nerves, forming part of the substance of the brain. 
How different these characters arc from those of the nerves of 
voluntary motion, which may be torn or twisted without 
giving pain to their owner, and perceive nothing but the man- 
dates of the will which they convey to the muscles, compel- 
ling them to execute the orders of the mind ! Still m 
ly removed from our received notions of sensation are the 
powers of the nerves of involuntary motion, for in health, the 
mind remains alike unconscious of the impressions made on 
them, and the actions which they determine; — yet even those 
nerves receive impressions from various causes, either internal 
or external, and proceed to the accomplishment of their right- 
ful duties, as if endowed with a special intelligence, not under 
the cognizance of the brain; and we can find no better term 
than sensibility, by which to express their function. 

The connexions of different nerves, take place in two dis- 
tinct ways, we have already stated, that the filaments arc not 
obviously combined together in any part of their course, but 
single threads, or groups of threads, from a bundle or nerve, 
are continually passing off in various directions to be distri- 
buted to the organs, or to unite with similar threads from 
other sources, to form a new nervous trunk. We often ob- 
serve a number of nerves, thus divided and reunil 
and again, until they form trunks, each of which contains - 
filaments from every one of the parent trunks; hence, results 
a nervous net work called a plexus. Now, these resulting 
nerves must possess compound functions, for each filament 
still retains the powers peculiar to its parent trunk, so that if 
such a trunk be divided or injured, the paitfl supplied by it 



OUTLINE OF ANATOMY. 



113 



may be deprived of several powers at once. For instance, 
each of the great nerves of the extremities originates in the 
spine by two distinct cords, which soon unite together as do the 
branches in a plexus; or rather, they are each formed of two 
nerves, which unite near their origin to form one trunk. If 
we cut the posterior nerve above the point of union, the cor- 
responding member loses the sense of feeling; if we divide the 
anterior nerve in the same manner, the limb loses its capacity 
for voluntary motion; but if we divide the united trunk, or 
any of its branches, we instantly deprive the parts supplied by 
the dissected filaments, of both motion and sensation. 

Fig. 26. 




A. Spinal marrow viewed in front. 

B. A spinal nerve. 

C. Anterior root of a spinal nerve. 

D. Ganglion of the posterior root of a spinal nerve. 

As the nature of this mode of communication is very im- 
portant in a practical point of view, I will give it one more 
illustration, at the expense of being compelled to anticipate a 
few statements belonging properly to other departments of the 
work. It is known that when any part of the body is injured, 
and the nerves of that part partake of the injury, the morbid 
effects of that injury are not confined to the corresponding ex- 
tremity of those nerves, but that the portions of the brain, 
spinal marrow or other nervous centres, in which the other 
extremity of the nerves terminate, are also affected, and this 
arrangement is indeed indispensable; for, by no other means, 
could those nervous centres receive instant intelligence of the 
mischief done, or threatened, so as to call into action the gene- 
ral powers of the system, to effect the work of defence or re- 
pair. 

Now if the injured nerve passes into no plexus on its way 
to the nervous centre, the consequent irritation of the other 
extremity is of course circumscribed within a small space, 

15 



114 OUTLINE OF ANATOMY. 

as when the eye is hurt by too powerful a glare of light, the 
optic nerve having no connexion in its course wi'h any other 
except its fellow on the other side, mischief occasional!; 
suits at the spot where those nerves arise, but not immediately 
in other parts of the spine or brain. But if the part injured 
is supplied with nerves from a plexus; the irritation is fre- 
quently extended to the origins of many or all of the nerves 
that contribute to form that plexus. Ilence, arise very com- 
plex symptoms from apparently simple causes, and a host of 
phenomena too often classed under the vague head of sympa- 
thy. Let us give one of the most simple examples. 

A man receives a hurt upon the arm or leg. 1 -am, 

for the injured nerves of feeling convey notice of the accident 
to the brain, but this is not all. The m mo- 

tion are intimately associated with those of feeling, and the 
former are likewise disturbed by the injury, so that not only 
is the patient led to avoid all motion of the part by the I 
cise of the will, but nature, desiring to render assurance doubly 
sure, deprives him in this way of the power of act 
rously, in opposition to her dictates. Now, it is not i 
prising that all the nervous filaments going directly to the 
wounded spot are so affected that the part becomes painful, 
and is deprived of motion; but the conservative efforts of na- 
ture do not stop here. The nerves of each extremity are 
numerous and leave the spinal marrow at various places, but 
they are all associated and combined together by means of 
plexuses; so that in severe injuries to any of their branch* I 
the various trunks take cognizance of the accident through the 
agency of their associated filaments, and thus the sensibility 
and motive power of the whole member become disturb* 
as to secure a desire or a necessity for keeping the whole 
limb as much at rest as possible; thus indicating the first and 
most important prescription in every case of local d 
injury. 

The train of effects is by no means finished at this point, 
but we are not yet prepared to pursue it farther. Knough 
has been said to prove the importance of this first mode of 
communication between the nerves, and to point out the man- 
ner in which nature herself guides the man of science in the 
study of symptoms and the application of remedies, let! 
him scarce any other duty than to second and support he: 
ertions. 

The other mode in which various nerves are associated, is 
by ganglions, which are small masses of nervous matter. 
terspersed with very loose cellular tissue, and sometimes with 
animal oil or fat. These ganglions seem to answer the pur- 
pose of little brains dispersed throughout the bodv, and hold- 



OUTLINE OF ANATOMY. 115 

ing jurisdiction over the operations of certain parts of the sys- 
tem. They possess no consciousness, at least in man. Many 
of the inferior animals have no other general nervous centres 
than a few associated ganglions, and display so little intelli- 
gence, that they are supposed hy many, to be entirely devoid 
of consciousness or will, we have already stated that these 
animals are supplied exclusively by the nervous system of or- 
ganic life. As we ascend in the scale of nature, we meet with 
animals still devoid of a proper head, but provided with one 
ganglion much larger than the others, to which they are all 
subservient. These animals have consciousness, will, and 
powers of voluntary motion. Their great ganglion has been 
dignified with the title of Brain, but its intimate structure has 
never been discovered. 

Led on by the analogy between the functions of this great 
ganglion, and the human brain, many physiologists have re- 
garded the latter as a ganglion also — but the progress of mo- 
dern anatomy has demonstrated the fact that the human brain 
is in reality composed of a number of systems of nerves per- 
forming various offices, and differing in function only, from 
the nerves of sensation, motion and organic life. The reason 
why this arrangement escaped detection for so many ages, 
was, that the nerves of the brain are not generally collected 
in bundles; nor are they invested, like the others, in distinct 
sheaths. They are spread out, so as to form a kind of nervous 
membrane, which is crowded into the head, like a crumpled 
handkerchief, and nothing but the most delicate dissection can 
unravel the confusion. In young children who have dropsy 
of the brain, the head sometimes increases enormously in size, 
and this nervous membrane becomes unfolded to a great ex- 
tent by the water accumulated within it. The child often re- 
tains its faculties for a long time, and, after death, the structure 
above described, is very obvious. 

The greater part of the ganglions, properly so called, belong 
to the nerves of organic life. They are connected together 
by nervous bands, so that they mutually influence each other. 
All the nervous fibres from the viscera, or bowels, and those 
that preside over the circulation, pass 'directly or indirectly, 
into one or other of these ganglions, and the fibres which en- 
ter the ganglion in this manner, often exceed in number those 
which connect with its fellows. 



116 



OUTLINE OF ANATOMY 
Fig. 27. 




a>a. A portion of intestine. 
b, b. Part of the aorta or great artery. 

c, c. Nerves of the intestine, following the course of the branches of the 
artery. 

The connexions of the ganglions of organic life with the 
nerves of sensation and voluntary motion through the medium 
of the spinal marrow of which we shall presently speak, in 
man, are numerous; even the eye is not entirely unconnected 
with them, and they are slightly associated by two routes 
with the nerves of the brain itself. 

These ganglions have the power of rendering the m 
which centre in them independent, to a greater or less extent, 
of all other parts of the system; but when acted upon by 
powerful causes, they may produce strong impressions upon 
the nerves of motion or sensation, and even on the brain. 
Disease of these latter organs may also occasion morbid ac- 
tions in the ganglions and their nerves, under certain circum- 
stances; thus proving the universal connexion of the various 
parts of the system with each other. Let us illustrate these 
facts by examples. 

Slight irritations of the intestines often give rise to diarrho?a 
or to that disturbance of the circulation which is commonly 
called internal fever, while the mind of the patient continues 
clear, and he attends to his business without feeling any pain 
or material uneasiness. In this case the danger is not immi- 



OUTLINE OF ANATOMY. 117 

nent. Information as to what is going on is conveyed, so to 
speak, to the ganglions, and nature intrusts the care of the 
case to them, without alarming the brain and other nerves, 
because their assistance is not required, and it is unnecessary 
that the patient should be conscious of the mischief going on 
within him. If the brain were troubled with messages upon 
every little accident that occurs in the bowels, the man could 
hardly digest his dinner in peace! 

When the irritation is much more severe or extensive, its 
effect extends beyond the ganglions, through the medium of 
their connexions with other parts of the nervous system. Thus, 
in spasmodic colic, the brain becomes perfectly conscious of 
the mischief, and the patient suffers so intensely, that he in- 
stantly seeks the relief which is so promptly necessary. In 
spasmodic cholera, which is accompanied by universal irrita- 
tion of the intestines, violent cramps of the voluntary muscles 
take place; and in many cases of fever resulting from inflam- 
mations of the lining membrane of the stomach or bowels, all 
the functions both of the mind and body become impaired. Some 
of the exemplifications of this law are very curious. Thus, an 
injury to the spine, often occasions palpitation of the heart, 
and diseases of the heart sometimes occasion all the symptoms 
of irritation of the spine: a chronic disorder of the stomach 
may produce total blindness; and the constant motion of sur- 
rounding bodies occasions vomiting or sea sickness, by the 
impression on the eye! With very delicate patients, in fevers, 
the motion of a rocking-chair in a sick room may endanger 
life! It is hardly necessary to adduce any more facts in or- 
der to show that diseases may prove highly dangerous in some 
cases before producing serious symptoms, and that the real seat 
of a disease is often widely removed from the part apparently 
most affected. 

The spinal marrow, of which we have already spoken, is a 
long mass of nervous matter, like the brain in many respects, 
which fills the greater part of the canal in the spine or back 
bone. It seems to be the centre of the nerves of motion and 
feeling, most of which pass off from it in pains through little 
holes between the several bones of the spine. These holes are 
much larger than the nerves, and are filled by soft cellular tis- 
sue, &c, which prevents the latter from being crushed or in- 
jured by the necessary motions of the bones; but in certain 
accidents, and in some diseases which occasion a thickening of 
the soft parts, they are pressed upon, and of course palsied. 
When the spinal marrow itself is firmly pressed upon, all those 
parts which are supplied with nerves originating below the 
injury are more or less completely deprived of motion and 
sen.s-i'Inn: and if the iniurv tnlrpa place high up on the back or 



118 OUTLINE OF ANATOMY. 

in'the neck, the nerves of organic life are disturbed in their 
operations to such an extent that the patient must die. If the 
injury is too slight to produce complete palsy, it not anfre- 
quently produces irregular convulsions. When only a part of 
the thickness of the spinal marrow is injured, there may be 
a loss of sensation without loss of motion, and vice versa. 

Among the lower order of animals which have a regular 
skeleton, such as the reptiles, the spinal marrow is very large 
in proportion to the whole mass of nervous matter, because 
their brains are remarkably small, being suitably adapted to the 
slender intelligence, or rather instinct, which is sufficient for 
their wants; but as we ascend in the scale of nature toward 
animals of more complex organization, we find the brain con- 
stantly enlarging its proportions and complexity, until the spi- 
nal marrow becomes a subordinate part of the nervous system. 



OF THE BRAIN. 

This grand and all-important organ, to the perfection of 
which man owes his high ascendency among the works of 
God, appears, at first, in the most imperfect animals that pos- 
sess it, as a mere excrescence or knob on the upper end of the 
spinal marrow; but becoming continually more and more in- 
volved, as the complexity of the animal, and the multitude of 
his necessities increases, until, in the lord of the creation it 
constitutes one of the most occult and difficult studies which 
the mind of man has attempted to grasp. Even the mere ar- 
rangement of its parts has escaped for ages the acuteness and 
the untiring industry of professed anatomists, and vain would 
be the endeavour to explain to the general reader, even the 
little now known of its structure and functions. A few broad 
and bold outlines, such as are absolutely necessary to the com- 
pletion of this anatomical view, are all that can be attempted 
here. 

When the bony case which contains the brain is laid open, 
we find it lined, throughout its whole extent, by a strong, 
thick, pearly, fibrous membrane, which even extends itself 
into the spinal canal containing the marrow. This membrane 
adheres strongly to the bones over which it passes, and a- 
in supplying them with blood vessels. It answers the pur- 
poses of an internal periosteum, but as its adhesions are not 
so firm as those of that membrane when the top of the skull 
is raised, it is torn loose from the bone, and continues to co- 
ver and conceal the brain. It is called, by anatomists, the 
Dura Mater, and is regarded as the outer membrane of the 
brain. 



OUTLINE OF ANATOMY. 119 

The inside of the dura mater is lined by another membrane 
so exceedingly thin and delicate that its existence is difficult 
to prove, except in certain stages of disease, on which account 
it is called the arachnoid or spider web membrane. It is re- 
flected from the dura mater so as to cover also the whole sur- 
face of the mass of brain, but without descending into all the 
inequalities of its surface. It enters some of the great fissures 
of the brain, and lines, also, certain cavities within the substance 
of the organ. 

This is a proper serous membrane, like the pleura in the 
chest, and the peritoneum in the abdomen, and answers the 
same purpose, namely, the prevention of friction from the mo- 
tions of the brain. It is also liable to the same diseases, such 
as violent inflammation and dropsy. 

Immediately beneath the arachnoid, we find another mem- 
brane much stronger than that just mentioned, but weaker 
than the dura mater. This is the pia mater, or proper mem- 
brane of the brain, which contains all the blood vessels which 
go into and return from the substance of the organ. It dips 
into all the inequalities of the surface, and lines the cavities 
of the brain, lying under the arachnoid. The violent inflam- 
mations of the head, attended with severe fever and delirium, 
or phrensy, are generally seated in these membranes, and not 
in the substance of the brain as is commonly supposed. 

After the removal of the membranes, the brain itself comes 
into view. It is a soft mass of gray and white pulpy matter, 
looking, at first, like a long intestine crowded together upon 
itself; but the convolutions, as they are called, are not com- 
plete: the fissures that separate them are shallow, and below 
them is found the central white mass of the brain, upon which 
these convolutions are based. 

If the brain be carefully lifted from the head, we shall find 
it almost divided into two portions, the one small, and marked 
by very narrow convolutions, lying underneath the hinder 
part of the other, which is many times larger, and is covered 
by much broader convolutions. 

The first of these portions is called the cerebellum, or little 
brain. It appears before the other portion in the order of for- 
mation, and is found in considerable perfection in animals that 
possess scarcely a trace of the larger and more important por- 
tion of the brain. 

The cerebellum is so intimately connected with the upper 
extremity of the spinal marrow, that the former has been re- 
garded by some physiologists as an excrescence upon, or pro- 
duction of, the latter. A great number of nervous fibres from 
the spinal marrow pass into the cerebellum, and are displayed 
through its substance, terminating in its convolutions. These 



120 OUTLINE OF ANATOMY. 

fibres constitute nearly the whole mass of the white or central 
part of the organ. The reader will not be surprised, then, to 
hear that the cerebellum exerts a very powerful influence over 
the functions of sensation and motion, which are the proper 
functions of the spinal marrow, and the nerves which form 
it. But as these functions are performed by animals in which 
the cerebellum can hardly be detected, such as the least per- 
fect reptiles, it follows that this portion of the brain must ex- 
ercise some office peculiar to itself. Physiological experiments, 
and the history of disease, sufficiently show that it assists in 
keeping the power of locomotion under the influence of the 
will, and that it is the seat of the instinct which tends to the 
continuation of the species. 

The larger portion of the brain, already mentioned, is called 
the cerebrum, and is the seat of the higher intelligences. It 
is divided by three deep indentations on it's sides and base, 
and another running lengthwise along its middle line, into six 
lobes, ranged in order, by pairs, and called the posterior, mid- 
dle, and anterior lobes. These parts, instead of being simple 
in character, and all designed to contribute to one purpose, as 
was formerly supposed, are now known to be composed of a 
multitude of parts which defy description in a popular work, 
each designed to fulfil the ends of its own creation. Among 
the lower orders of the vertebrated animals, the first parts which 
appear are those that form the back part and the base of the 
cerebrum, which are supposed by phrenologists to be the seats 
of those instincts which are necessary to self-defence, the pro- 
tection of offspring, the procuring of suitable food, &c; and 
it is a most curious fact, that the order in which the develop- 
ment of these several parts is observed to take place, u 
ascend in the scale of creation, corresponds astonishingly with 
the habits of the several animals examined. The same remark 
is true with regard to the order of their growth in man as he 
advances from infancy to age, changing the form of his brain 
according to the nature of his necessities, and his relations, and 
duties in life. 

It is only among the more perfect vertebrated animals that 
we find the middle and anterior lobes of the cerebrum in a 
state of considerable development; and the superior portions 
of these lobes are brought to perfection in man alone. 

According to the doctrines of the phrenologists, the back 
part of the posterior lobes of the brain is the seat of those in- 
stincts which are necessary to the protection of the offspring 
during the helplessness of infancy; the lower part of the mid- 
dle lobes is the seat of those propensities which are absolutely 
necessary to self-defence, self-support, and the pursuit of ] 
namely, the disposition to combat and destroy. 



OUTLINE OF ANATOMY. 121 

Thus far, the doctrines of phrenology which have produced 
so much discussion of latter years, may be regarded as fully 
established; the evidence is too powerful to be resisted, as 
" he who runs may read." The order in which these portions 
of the brain are developed, both in ascending the scale of ani- 
mated nature, and in the growth of the human embryo; their 
comparative bulk in various animals, answering precisely to 
the habits of those animals; their actual size in the different 
sexes and individuals of the same species, corresponding with 
their different duties and shades of character; the history of 
insanity and idiotcy; and the influence of education and habit 
on the form of the head, prove, beyond a doubt, the correct- 
ness of the doctrine. But the functions of the other portions 
of the brain, which are either peculiar to man, or are possessed 
by him in common with but few other animals, are not so 
easily determined. 

As this is no suitable place for discussing in detail the pe- 
culiar views of Drs. Gall and Spurzheim, I shall merely re- 
mark that according to the doctrines of these philosophers the 
anterior lobes of the cerebrum are the scat of those organs 
which the mind employs in perceiving the relations and pro- 
perties of external things, and in reflecting and reasoning upon 
them; while the upper portions of the middle lobes are chief- 
ly occupied by the organs of the moral sentiments and feel- 
ings. 

In offering this extremely imperfect sketch of the ground- 
work of a much debated science, I do not design to express 
any opinion, on the manner in which the principles of that 
science have been carried out in detail, but the few facts which 
have been stated possess a degree of importance in practice 
which would have rendered their omission improper; for they 
illustrate some beautiful positions in hygiene and the treat- 
ment of disease, as will be seen in the sequel. 

The reader must not suppose, however, that the whole mass 
of the cerebrum is devoted to the independent and internal 
actions of the mind. Presiding over, influencing, or deter- 
mining, as this organ does, the purposes and effects of nearly 
all the actions performed by the body and its several parts, it 
necessarily requires a complex apparatus to connect it with 
the other portions of the nervous system; no inconsiderable 
part of this apparatus is contained within its substance, and 
tends to increase its bulk. Like the cerebellum, it receives 
from the spinal marrow a great number of fibres which spread 
themselves out and pass on to the convolutions in a similar 
manner. Other fibres, originating in the convolutions, run in 
the opposite direction until they are lost in the spinal marrow. 
From the basis of the brain, the nerves of smell, sight, and 

16 



122 OUTLINE OF ANATOMY. 

hearing appear to pass off, as do also those nerves which give 
sensation and motion to the head and face; and the system of 
organic nerves, is also connected with the brain in a manner 
too complex to be here described. Thus the cerebrum is close- 
ly associated with all parts of the animal economy, and the 
mind, enthroned like a spider in the centre of his web, feels 
the impulse of every impression made even on the remotest 
confines of its dominion. 



ON THE DUPLTCATURE OF CERTAIN ORGAN 

It is a singular fact, that the organs most essential to the 
mere existence of an animal; — those, I mean, which are found 
in all, or nearly all animals, however simple; those which act 
in a manner independent of the will, and without the indivi- 
dual being conscious of their action — are, for the most part, 
very irregular in form, and single. Thus, man has but one 
stomach; and in those animals which are provided with more, 
the different stomachs do not resemble each other, nor do they 
fulfil the same purposes in the economy of the system: they 
are, therefore, to be regarded rather as different organs mis- 
called by the same name, than as duplicates of the same Ol 
This is true with regard to the ox, and other ruminating ani- 
mals which have several cavities commonly called stomachs. 
In nearly all animals, there is but one intestinal canal, — the 
exceptions to this rule being found only in a few species of 
marine shell-fish. Man has but one heart, the two sides of 
which do not resemble each other; his principal blood vessels 
are single, and, if many of the main corresponding branches 
passing to or from the opposite sides of the body resemble 
each other in position, this results rather from the necessary ef- 
fect of the form of the parts through which they pass, than from 
their being formed by nature on the same model. Moreover, 
the resemblance is never very strict, and the distribution of 
the minute branches becomes exceedingly irregular and un- 
certain. Parts of this single, or irregular character are called 
the organs of vegetative or organic life. They fulfil the pur- 
poses of digestion, nutrition, respiration. &c. — functions with- 
out which no animal, however simple, can exist. These parts 
of the body are governed, more immediately, by the iu 
of organic life, which have been noticed alreadv. 

But, on the contrary, those parts of the more perfect ani- 
mals, which place them in connexion with surrounding t! 
which are under the government of the will, or contribul 
the perfection of the external senses, are always arranged in 
pairs; the organs being almost exactly similar on the opposite 



OUTLINE OF ANATOMY. 123 

sides of the body. Thus, man has two arms, and two legs, si- 
milar, each to each. All the organs of his external senses are, 
in like manner, double, even to the nose, which, though appa- 
rently single, is composed of two nostrils, alike, or very near- 
ly alike, in all respects. These duplicate parts are called the 
organs of animal life, and are under the government of the 
nerves of animal life, or, as it is sometimes called, the life of 
relation. 

There are other parts of the body, of a mixed character, 
being partly under the influence of the will, and partly inde- 
pendent of it, such as the ribs and muscles of respiration, &c; 
and these parts, though double, are less symmetrical and more 
subject to variety of form, than those which appertain exclu- 
sively to the life of relation. 

All parts of the brain are double; hence, the organs of 
thought and of instinct are precisely alike on both sides of the 
head, excepting in cases of individual or hereditary disease, and 
if a portion of one side of the brain be injured or removed, it 
is possible for the other side to execute all the mental opera- 
tions; as a man may continue, after the destruction of one eye, 
to see accurately with the other. But as a man sees but one 
image of an object, although that object is painted on the re- 
tina of each of his eyes, so his mind performs but one opera- 
tion at a time, although both sides of the brain may be called 
into action. Now, in order that the opposite portions of the 
brain may always act in concert, and thus prevent confusion, 
there are several bundles of nervous fibres within its substance 
that pass from one side to the other, connecting the corre- 
sponding parts with each other, and answering no other pur- 
pose than to produce this consentaneous action. These con- 
nexions are called the commissures of the brain. It is proba- 
bly in part owing to a similar connexion known to exist be- 
tween the optic nerves, that we see but one image with both 
eyes, and that when only one eye is injured, both are so very 
liable to inflame at the same time. 

It would verge perhaps on the ridiculous, if we were to car- 
ry our analogy farther, and conclude that because the eyes 
perceive two images of the same object in squinting, that cer- 
tain instances of mental obliquity might be accounted for, 
upon the same principle; but, jesting aside, there are certain 
mental phenomena displayed occasionally in disease, that ren- 
der it at least probable that the two sides of the brain are ca- 
pable, under certain circumstances, of acting independently, 
and in a manner different from each other. The writer of 
these pages formerly had the pleasure of a personal acquaint- 
ance with a lady whose case, at one time, attracted very ge- 



124 OUTLINE OF ANATOMY. 

neral attention, having been made public by the late Dr. Mit- 
chell, of New York. 

' She became subject to convulsions, after having arrived at 
mature age, and after the first attack had passed over, she was 
found completely ignorant even of the alphabet, and it became 
necessary to teach her like a child. Her progress, however, 
was very rapid, and she soon acquired the command of lan- 
guage, but her memory of past events was so completely lost, 
that she read her bible with all the zest of novelty, and was 
exposed to danger on several occasions, from her want of 
knowledge of the habits of animals, and the properties of 
things, with which she had been familiar from infancy.* Her 
fits returned at long and increasing intervals, and after each 
attack she remembered every thing that she had known at 
the time of the preceding paroxysm, but was totally uncon- 
scious of any occurrence that took place during the last inter- 
val. Thus she appeared to possess two sets of ideas, which 
intermitted with each other, and so complete were these changes, 
that she might almost be said to have two individualities! 
When in one condition, she was always seriously inclined, 
somewhat taciturn, and disposed to melancholy; in the other, 
she was loquacious, was lively, wrote poetry, was given to 
reparte, and read novels with avidity. In both states, she 
was decidedly intelligent, and became accomplished, without 
displaying any traits that would have led a stranger to suspect 
aberration of mind. 

Many cases of this character are on record, and some of 
them are too well authenticated to admit of doubt. 

It is not pretended that these instances furnish positive 
proof of the occasional independent action of the two sides of 
the brain, for they may be explained, though not so simply. 
upon other principles. They are noticed here, as strongly il- 
lustrative of the complexity and mysterious character of that 
machine, with which ignorance and empiricism have the au- 
dacity to tamper so often and so rashly. 

There is one circumstance connected with the duplicate 
character of the brain, which it is highly important to men- 
tion. 

The fibres which have been already described, as connect- 
ing the cerebrum with the spinal marrow, run across each 
other near the place where they join the latter organ, so that 
those which pass to or from the left side of the cerebrum, go 

* She once seized a large rattlesnake by the tail, as it was entering a hole in 
the ground, and owed her life to the strength of her intended prey and the 
slipperiness of its integuments. 



OUTLINE OP ANATOMY. 125 

to the right side of the spinal marrow, while those on the 
right side of the former are connected with the left side of the 
latter. This arrangement accounts for the remarkable fact 
that, in fractures, or other severe injuries on one side of the 
head which produce palsy or convulsions, these symptoms 
generally occur on the opposite side of the body. When 
palsy, or convulsions are confined to the same side with the 
injury, it is rendered probable, (though perhaps not certain,) 
that the cerebellum, or some of the parts near the summit of 
the spinal marrow are wounded, and that the cerebrum has 
escaped. 

Here we will leave the subject of anatomy, after having com- 
pleted such an outline as is fitted to amuse and instruct the 
general reader. We may find it necessary, as we advance in 
the work, to give some farther details with regard to particu- 
lar organs; but when this is the case, the anatomical descrip- 
tions will be found prefixed to the chapters, or sections, 
which treat of the diseases of those organs. 



126 PHYSIOLOGICAL REMARKS. 



CHAPTER III. 

PHYSIOLOGICAL REMARKS. 



If it be difficult to convey to the general reader any thing 
like a complete notion of the structure of the human body, it is 
still more difficult to communicate a knowledge of its various 
actions. Hence, if we have been compelled to be v 
ral in our anatomical remarks, we are under still stronger com- 
pulsion to limit our range in the field of Physiology* Pur- 
suing, then, the plan of teaching already adopted in this work, 
we shall confine ourselves to the consideration of such points 
only, as are both necessary to our future design, and intelligi- 
ble to unprofessional readers; beginning with the most simple 
ideas, and gradually enlarging the field of view as we ascend 
to more complex operations. 

Physiology is the science of life, and treats of the operations 
and actions performed by living bodies when in a state of 
health. It has been customary to give a different name to the 
science that treats of the same actions when in a state of dis- 
ease, which is called Pathology: but these branches are as in- 
timately connected with each other as is the art of making a 
watch, with the art of keeping it in order. However conve- 
nient such a division of the subject may be for those whose 
lives are spent in the prosecution of such studies, it is too ar- 
tificial for our present purposes, and we shall disregard the 
distinction in the few remarks which follow. 



OF ASSIMILATION AND NUTRITION. 

In the section of the last chapter, some idea of the me- 
chanical process of nutrition was attempted to be given, but 
nothing was said of the power by which an animal bod 
lects, from the food taken into the stomach, or from the me- 
dium by which it is surrounded, such particles onlv, as are 
necessary to support the body, or the various organs which it 



PHYSIOLOGICAL REMARKS. 127 

contains, while it rejects those particles which are noxious or 
useless. Of this power we propose to speak at present. 

We have already spoken of that singular property by which 
animal membranes, such as strips of bladder, mucous membrane, 
&c, are enabled to pass certain fluids through their substance 
in preference to other fluids; and it has been shown that the 
substances thus transmitted, are not always those which escape 
most rapidly when exposed to the air, or left in a vessel un- 
confined. The experiments of Dutrochet, Farraday, Mitchell, 
Rodgers, and others, have proved that the same power exists 
in all animal, and probably, in all organized membranes after 
death, and a multitude of facts in the physiological history of 
man and animals, might be adduced to show that similar ope- 
rations are constantly taking place in the living body. 

But there is a still more curious and important truth con- 
nected with this subject. The same membrane will transmit 
one substance with facility in one direction, while another 
can only pass with freedom in the opposite direction! 

Now, although both living and dead matter possesses this 
power, there are many circumstances in the history of disease 
and death, which prove that the vital principle exerts a con- 
trolling influence over its displays. Thus, the colouring mat- 
ter of the bile appears to be retained entirely in the gall blad- 
der during health, and in bodies examined a few hours after 
accidental death, we generally find the outside of that recep- 
tacle of a natural colour with an unstained pearly surface; but 
in persons who have been destroyed by hepatic complaints, 
and those who have been dead for a considerable time, this 
surface, together with the neighbouring bowels, are often 
found deeply imbued with the yellow or brown colour of 
the bile. Many other facts of a similar nature might be 
mentioned, but it is suflicient for our present purpose to men- 
tion one of them, which comes continually under the observa- 
tion of every anatomist. It has been mentioned, in the appro- 
priate section, that the cuticle, (see page 107,) which covers the 
whole external surface of the body, is altogether divested of 
openings or passages, and that the belief in the existence of 
pores in the skin, is an error. This belief has resulted from 
the appearance of the membrane, where its lines or grooves 
intersect each other, and where the hairs are implanted. The 
inference, that passages exist, drawn from seeing the skin be- 
dewed with large and scattered drops of sweat, is equally 
unfounded, for this appearance is at once explained by the 
power of which we have been speaking, as resident in all ani- 
mal membranes. It is now no longer doubtful that the skin 
transmits outwardly through its substance not only the va- 
pour of the insensible perspiration, but the fluid which bathes 



128 PHYSIOLOGICAL REMARKS. 

the whole surface during violent exertion, or exposure to the 
heats of summer, together with the salts well known to be 
contained in this secretion. It is also known that the same 
skin is capable of transmitting, inwardly, certain substances 
which are applied upon its outer side, and this is done, with- 
out the aid of any vessels, by a vital power residing in the 
membrane itself, altogether different from capillary attraction, 
or that power by which unorganized and spongy bodies im- 
bibe a fluid which is placed in contact with them. That this 
property of membrane is a vital and not a mechanical one, is 
proved by the fact that it is diminished or arrested in certain 
stages of disease, as, for instance, in the hot stage of certain 
fevers, when the supply of blood to the surface is even greater 
than usual — while it is increased a hundred fold in other mala- 
dies, such as malignant cholera, when the external circulation 
is almost destroyed! The very recent experiments of Dr. 
Rodgers on this subject, {American Journal of Medical 
Sciences, August, 1836,) appear like the dawning of a new 
morning over the darkest regions of Physiol . 

Now, although the mucous membranes of the alimentary 
canal are believed to be deprived of cuticle throughout nearly 
their whole extent, yet it does not follow that the extremities 
of the lacteals, or other vessels, which take up the nutritious 
particles of the food from the surface of these membranes, are 
open, or that they ever reach quite to the cavity of the bowels. 
Anatomists have never demonstrated the existence of any con- 
nexion between the vessels and the surface, in any part of the 
body, although our coloured injections of the blood vessels 
are often carried to such a degree of minuteness that the fluid 
employed flows into the intestines and fills them, — leaving the 
colouring matter behind, in the vessels. But this result, as 
well as the secretions of the bowels, and the absorption of the 
nourishment of the system, may all be accounted for on the 
principle already laid down; by which living membranes trans- 
mit through their own substance, in opposite directions, the 
various substances which nature designs to employ in, or re- 
ject from the system. 

Among the simplest animals, which are not provided with 
nerves or blood vessels, and in which, if they have cavities, 
the inner and outer surfaces are apparently alike, the whole 
process of assimilation appears to be perfected by the external 
membrane or tissue, without any other aid; but in the complex 
animals and man, though the inherent powers of the tissue 
still remain, the process of assimilation cannot be completed in 
this simple manner. The chyle taken up by the lymphatics, 
is not blood, though it is evidently an organized fluid: it must 
pass through the lungs before it becomes fitted to nourish the 



PHYSIOLOGICAL REMARKS. 129 

system. The lungs in man, then, assist in this process. The 
blood is not muscle, though the fibres of muscles are formed 
from the materials which are supplied from the blood by se- 
cretion, and the same remark is true of all the various organs 
of which the body is composed, and consequently, the process 
of secretion is but a particular form of assimilation. 

The same arguments which show that the reception of nou- 
rishment into the system is, in all probability, the transmitting 
power of the membranes — and chiefly, of the mucous mem- 
branes — tend with equal force to prove that the secretion of 
the materials of the different organs, or, in other words, orga- 
nic nutrition, is also the result of the same power. The ves- 
sels which supply the several organs of the body have never 
been proved to terminate with open mouths, nor has it been 
shown that they are porous — and although many medical doc- 
trines have been based upon the supposition that they are con- 
structed with one or other of these species of orifices — the 
idea is purely hypothetical. It amounts to no more than a 
guess, or if supported by seeming facts, these are the result 
of microscopic observations of a very questionable character. 
On the other hand, the doctrine which attributes the nutrition 
of the organs to the transmitting power of the membranes 
which form the coats of the vessels, and enclose the particles 
of the organs and tissues, (see page 126,) stands upon facts of 
greater weight, because they can be observed on a greater 
scale. 

In the present state of our knowledge, then, it is more cor- 
rect to consider the first and last steps of nujrition, as well as 
the formation of secretions as phenomena, characteristic of the 
vital organization of tissues, and not produced, as is still gene- 
rally believed, by the blood vessels themselves. 

These remarks may appear to contradict the opinion de- 
fended in the first chapter of this work, where it is urged that 
the cellular tissue is the fundamental tissue, by which all parts 
of the body are formed, and in which their particles are depo- 
sited; for, it will be asked, if there is but one fundamental 
membrane in the body, and if all the other tissues are composed 
of this, and certain matters thrown down into its cells; and if 
it be true that absorption and secretion are the result of a pro- 
perty inherent in the membrane, how can it happen that all 
parts of the body do not absorb and secrete in the same man- 
ner? The answer is a plain one. The interstitial deposites 
do certainly modify the vital powers of the organs or com- 
pound tissues into the formation of which they enter. They 
are new agents in the vital chemistry of the parts; and it would 
be as unreasonable to suppose that cellular tissue complicated 
with bone or muscular matter, would produce precisely the 

17 



130 PHYSIOLOGICAL REMARKS. 

same action with cellular tissue in a free state, as to suppose 
that sulphuric acid combined with lime or potash, would act 
in' the same manner with sulphuric acid when in its pure or 
isolated condition. The experiments of Dr. Rodgers suffi- 
ciently prove that, the transmitting powers of the peritoneum, 
the mucous membrane, the substance of the liver, and the 
bladder are widely different from each other, while they are 
sufficiently energetic to effect the decomposition of metallic 
salts even after the tissues have lost their vitality! When it 
is recollected, in addition to these facts, that in the more com- 
plex animals, the nerves exert an important influence in modi- 
fying, according to circumstances, the vital properties of the 
parts to which they are distributed, it cannot appear surprising 
that we should witness such various effects in different por- 
tions of the body, from the operations of assimilation and nu- 
trition. 

But, in the former chapters of this work we have spoken 
of the capillaries as active agents in the two intimatelv 
ciatcd processes just mentioned; and this may lead the reader 
to tax us with inconsistency, in Attributing such extensive 
powers to the tissues themselves. Let us, then, explain the 
agency of the blood vessels, in the support of the principal 
functions of organic life. 

The blood vessels are the conduits which convey the fluids 
that have undergone that process of assimilation which fits 
them for nourishing the several organs of the body, to the 
parts where they are required. They also convev those mat- 
ters which have ceased to be useful, to the different apparatus 
designed to discharge them from the system. The capillaries, 
by means of their strong fibrous coats* and their capability of 
dilating or contracting extensively, determine, in great d< g 
the quantity of blood directed to any particular part, and the 
rapidity of its motion when there. So lon^ as a part remains 
healthy, it is a general rule that the greater the amount of 
blood which passes through it in a given time, the more active 
are its functions; but the reverse of this is often observed in 
disease, for the excessive and rapid supply of blood will some- 
times arrest the functions, as has been remarked of the skin in 
the hot stage of some fevers, and an extreme slowness of the 
circulation sometimes appears to favour certain secretions: 
which fact, as we have already mentioned, may be observed 
in the skin and mucous membranes during the malignant cho- 
lera. The power of the capillaries in regulating the circula- 
tion, is much influenced by the nerves, which thus exert an 
indirect influence over the processes of assimilation and nutri- 
tion not less important than their direct eflect on the vital pro- 
perties of the tissues. 



PHYSIOLOGICAL REMARKS. 131 

But the nerves themselves depend upon the capillaries for 
the preservation of their own functions. If they are supplied 
freely with blood, they act with energy, and under other cir- 
cumstances they generally become debilitated, and nutrition 
is carried on with greater or less facility, according to the con- 
dition of the nerves of the part. 

Again, if the quality of the blood be vitiated, as it may be 
by improper diet and other causes, both the nerves and the 
other tissues must suffer for the want of their proper stimulus, 
and the materials for their support, and assimilation and nutri- 
tion must necessarily become disordered. 

It appears, then, that the processed of assimilation and nu- 
trition, the most important functions of the animal organiza- 
tion, depend upon four principal circumstances: — 1st, the con- 
dition of the membrane; 2d, the proper composition of the 
blood; 3d, the action of the blood vessels — and4lh, the influ- 
ence of the nerves. The disorder of either of these circum- 
stances is sufficient to induce disease; and as they are all by 
nature mutually dependent on each other, it follows that nei- 
ther of them can be disturbed without affecting all the others. 
It is often impossible to determine where the first link in the 
chain of morbid action is located; and it is sometimes equally 
difficult to discover the starting point in the train of causes 
which produce disease. Witness the history of epidemics and 
hereditary affections, — the former resulting from some wide- 
spreading physical influence, perhaps — like the secret agents 
which engender cholera and influenza — co-extensive with the 
whole globe: the latter, consequent upon the misfortunes, and 
it may be, the crimes of our progenitors! 

It has been customary for the unprofessional public to smile 
at the science of medicine, because its teachers and distin- 
guished fellows have differed widely from each other in their 
theoretical opinions; but it should be remembered that short 
of the dogmas of revealed religion, there are no indisputable 
truths but those of well demonstrated mathematical proposi- 
tions. 

The doctrine of gravitation, by means of which the science 
of mechanics has been brought to its present high perfection, 
is founded upon a mere hypothesis — a word of eleven letters 
used to express what none can comprehend! Eclipses were 
calculated long before the days of Newton by those who 
thought the sun moved while the earth stood still, and whose 
descendants now believe the world to be a plane! 

No one will pretend that the theories of Newton have not 
been of incalculable advantage in the application of science to 
the practical affairs of life; yet they do not explain the first 
cause of any planetary movement — and already the progress 
of the chemistry of imponderable fluids begins to threaten the 



132 PHYSIOLOGICAL REMARKS. 

foundations of his system. Its just conclusions, indeed, can- 
not be overthrown, for they rest upon innumerable observa- 
tions. Just so, the various medical theories which have chased 
each other rapidly into oblivion from the times of Hippocrates 
to those of Broussais — though all are partial and imperfect — 
have tended, each in turn, to advance the science and give 
birth to ideas more and more important and correct.* They 
are like so many steps or terraces upon the mountain of science, 
whose summit, illuminated by the clear rays of truth, is wise- 
ly placed above the region of the clouds, unattainable in this 
state of existence. 

The chief cause of the diversity of medical theories has 
been the habit of attributing the phenomena of the disease 1o a 
disorder in only one or two of the four circumstances enume- 
rated as influencing the processes of assimilation and nutrition, 
to the neglect of the others. Thus, the solidists accounted 
for all morbid actions by attributing them to changes in the 
condition of the tissues, forgetful of the obvious fact that those 
very changes are the result of previous disease, and, therefore, 
cannot be regarded as a safe starting point in medical reason- 
ings, though they furnish satisfactory explanations of many 
important symptoms. 

The humoratisis, on the contrary, referred every thing to 
the condition of the fluids, unmindful of the fact that these 
very fluids are formed by the action of the solids upon exter- 
nal matter. The followers of Cullen directed their attention 
chiefly to the condition of the capillaries and the nerves, to 
the exclusion of the blood and the other tissues. Waving the 
less detailed doctrines of Brown and Rush, the theory of 
Broussais carries generalization to a greater extent than any 
of its predecessors; but it was scarcely matured, before many 
facts were accumulated which could not be embraced within 
its limits! 

In the midst of all these revolutions of opinion, the science 
has been steadily advancing, and continually arranging in sys- 
tematic manner, a larger and larger circle of facts. We are 

• We must refuse this praise to some of those wild dreams which now agi- 
tate the public mind— such as that German doctrine which teaches that the 
half is greater than the whole! and that the best mode of rendering a disease 
better is to make it a little worse.'— the still less rational position of those who 
hold, that because mineral medicines are sometimes poisonous, we should con- 
fine our treatment to the use of vegetables and "herbs;' which are often much 
more poisonous!— and the opinions of those who think that " life is fire.'"— and, 
like the Ghebers of old, worship its personifications in cayenne pepper and the 
hot bath! These may be classed with the fancies of Paracelsus, when that 
great reformer "drew upon his imagination for his fads." These doctrines 
are intangible, and the medical profession has no pecuniary interest in opposing 
their ascendency, for they certainly do not diminish its emoluments. 



PHYSIOLOGICAL REMARKS. 133 

still far from the comprehension of first causes in Physiology; 
but those who tax the profession with empyricism, in conse- 
quence of the apparent contradiction between contending opi- 
nions on medical theory, betray a partiality and narrowness 
of judgment. All the doctrines noticed are true to a certain 
extent, and all have contributed their share in promoting the 
application of truth to practice. Even when they sink beneath 
the scythe of Time, their influence continues to add strength 
to those which rise upon their ruins, as the decaying tree gives 
richness to the soil from which the stem of its successor draws 
its nutriment. 

As the processes of assimilation and nutrition, viewed in 
the very extensive sense which we have given them, include, 
directly or indirectly, all the Oligemic functions of an animal, 
their disorders embrace the whole field of morbid action, or 
disease, so far as it results from the operation of external causes. 
The nature of life itself, and of the nervous influence, like gra- 
vitation, chemical reaction, and all other first causes in philo- 
sophy, is placed beyond the limits of our knowledge, and 
though there is much in the history of epidemics and heredi- 
tary disease, which tends to prove that these causes themselves 
are altered in their action by changes in the organization of 
the individual, or by atmospheric influences, it is at present in 
vain to argue upon the modifications of disease which proba- 
bly result from these alterations. In this department of our 
science, the duty of the physician is now, and in all probabi- 
lity will for ages continue to be the accurate observation and 
careful record of isolated facts. 



OF THE REPRODUCTION OF PARTS, AS DISPLAYED IN 
THE HEALING OF WOUNDS. 

The mechanism of nutrition in the first production of the 
human body, is a subject involved in extreme obscurity and 
difficulty; nor is it at all adapted to the character of a popular 
work. But, in the history of the healing of wounds, we are 
able to perceive, more clearly, the mode in which nature pro- 
duces the several organs of the body, by means of close obser- 
vation on her mode of operating in the reproduction of parts 
of the body which have been divided or removed by acci- 
dent. 

When a clean cut has been made by a sharp instrument, in 
a part which contains no very large blood vessels, it is ob- 
served that the nerves of the part are stimulated; or, in other 
words, the patient suffers pain, if the wound occur in any or- 
gan supplied with nerves of sensation. Very soon after this 



134 PHYSIOLOGICAL REMARKS. 

moment, the capillary vessels of the part are found enlarged, 
and more blood is admitted into the neighbourhood of the in- 
jury than is usually found there. This proves that the circu- 
lar or muscular fibres of the capillaries have been relaxed, and 
that the vessels are increased in size. As an inevitable conse- 
quence, the colour of the part is heightened, and so long as 
the process is consistent with health, the functions of the part 
are increased in rapidity, its hue approaches to that of arterial 
blood, its sensibility is increased, its temperature is elevated 
above the customary standard, and the part is in some degree 
swelled or enlarged. This condition has been erroneously 
designated by a term which is invariably associated with the 
idea of local disease. This term is inflammation. 

Inflammation is described to be a state of any particular part 
of the body, characterized by an increase of heat, redness, 
swelling, (i. e. fulness,) and pain, (i. e. sensibility.) A better 
description of high health could hardly be given! If we com- 
pare the young child with the adult man, we find him distin- 
guished by a comparatively greater amount of heat, redness, 
fulness, and sensibility! — that is, he labours under universal 
inflammation! If we were to examine the fcetus before 
birth, it would be found possessed of these same characteris- 
tics in a still greater degree, if the term sensibility be extend- 
ed to the perceptions of the nerves of organic life! After a 
hearty meal it is well known that the heat, redness, fulness, 
and sensibility of the stomach are decidedly increased — and 
this increase is carried so far that symptoms analogous to a 
slight chill and fever are the natural consequence. In the 
terms of the definition, then, it would be perfectly logical to 
say that, after dinner, a man labours under inflammation of 
the stomach — a very serious disease called gastritis by phy- 
sicians! 

The very close analogy between the healthful operations of 
the body in restoring wounded parts, and the phenomena of 
actions universally acknowledged to be morbid, has led many 
professional writers to the adoption of the term ''healthy inflam- 
mation" to signify the former class of vital effects. But the 
employment of the same name to designate states, both of 
health and disease, is calculated to produce endless and inex- 
tricable confusion in the minds of those who seek information 
in the science without the means and leisure to become pro- 
found. I shall, therefore, reject the term inflammation in the 
present work, while speaking of the healthful process by which 
parts are reproduced, reserving it as a title for certain* morbid 
trains of symptoms which will be described hereafter. 

In perfectly simple cuts, occurring in healthy individuals, 
the process of restoration is exceedingly easy, provided the 



PHYSIOLOGICAL REMARKS. 135 

<5«t surfaces be kept accurately in contact with each other by- 
mechanical means. The vital actions of the part being ren^ 
dered more active in the manner already described, the wound- 
ed cellular tissue pours out a glutinous fluid analogous in ap- 
pearance to that which fills the cells of the foetus at a very 
early stage of growth, and that which is found in the structure 
of the simplest animals. This fluid gradually hardens, bind- 
ing the cut surfaces together, until, in a few hours, it becomes 
a part of the cellular tissue, and soon afterwards, minute 
branches of blood vessels from the neighbouring trunks are 
found to have penetrated it in all directions, so as to consti- 
tute it regularly a portion of the living body. If the health 
and constitution of the patient be good, this process is effected 
promptly, and without accident. Hence the extreme folly of 
those nostrums which are so often administered in "fresh 
cuts," and which are so exceedingly prone to produce the very 
mischief they are applied to prevent. Afresh cut requires 
no other precaution, after the bieeding is checked and the 
wound cleaned, except that its edges should be kept in con- 
tact as nearly as possible, and the external air excluded as 
completely as convenience will permit. If the patient be very 
weak, or unusually excited, the part may become diseased and 
may then require other treatment; but these conditions will 
be considered hereafter. 

When a compound organ, such as a bone, muscle, or nerve, 
is divided by the cutting weapon, the union is effected in the 
same manner; but a very long time elapses, after the union is 
effected by the cellular tissue, before the peculiar intestitial 
deposites which form the organ are thrown out in such a man- 
ner as to restore its proper functions. In a muscular part, this 
result is not completed for many weeks; in a bone, it occu- 
pies some months; and in a nerve, several years elapse before 
it is entirely finished. Even the brain itself has been known 
to unite in this manner after a wound; but this effect is ac- 
complished with so much difficulty, that the number of in- 
stances on record are very few. It would appear, therefore, 
that the later an organ is produced, in ascending the scale of 
nature, the more difficult is its reproduction. Man, like a 
zoophyte, can renew a portion of cellular tissue with ease, but 
as this tissue forms nearly the whole organization of the lat- 
ter, if it be cut in half, each piece forms itself into a perfect 
animal; while in man, the complexity of the organs renders 
their renewal difficult long after the union of the tissue in 
which they are imbedded. 

If the wound inflicted should occasion a loss of any portion 
of the solid substance of the part on which it is inflicted, na- 
ture apparently pursues a very different course in effecting a 



136 PHYSIOLOGICAL REMARKS. 

cure, but it is in reality the same in principle. In this case, 
the sides of the wound cannot be kept in contact by mechani- 
cal means, but continue gaping, and more or less exposed to 
the external air. If the wound be small and the part remain 
entirely uncovered, the glutinous fluid which has been already 
mentioned, gradually fills the vacancy, and often rises far 
above it, becoming dried by the air, and converted into a scab, 
beneath which the union makes regular progress without any 
change in the secretions of the part. This mode of cure by 
scabbing is often the best which can be accomplished by the 
surgeon, who should encourage it whenever circumstances 
permit. The greatest inconvenience attendant upon it results 
from the hardness of the scab and its disposition to contract, 
so as to irritate the surrounding parts; but this can be gene- 
rally relieved by touching it with oil, or by frequent bathing. 

But when the wound is large, or when it is dressed, from 
the first, with an ointment, it will not form a scab; and the 
surface of the cellular tissue of the wound secretes a new mem- 
branous covering, probably formed by the glutinous exudation 
already mentioned. This membrane soon becomes organized 
and begins to secrete matter, or pus, which keeps the wound 
continually moist, and prevents the irritation which would 
otherwise inevitably result from the drying effect of the air. 

While the pus is forming and flowing from the wound, the 
membrane and the surrounding parts are becoming continual- 
ly more and more vascular, until the wound is rendered in- 
tensely red; and, in the mean time, the cells of the cellular tis- 
sue are distended with an increased serous or other deposite, 
so that they swell up more and more, and the whole surface is 
covered with little conical eminences, resembling flesh, called 
granulations, which shoot from all points toward the centre 
of the wound and the surface of the skin, and wherever the 
sides or summits of these eminences come in contact with 
each other, they unite and close that part of the wound, thrust- 
ing up before them the membrane which secretes the pus, un- 
til at length it is raised nearly to the level of the skin. The 
membrane then becomes thickened; a great deal of fibrous mat- 
ter is deposited in it, the secretion of pus ceases, the heat and 
redness decline gradually, and it dries, — assuming the charac- 
ters of an irregular skin. The wound is then said to be healed 
or cicatrized. 

After this is accomplished, the absorbents remove the unu- 
sual deposites of fluids from the cellular tissue, and also from 
the substance of the scar, which contracts powerfully, but al- 
ways remains irregular in form, and more liable to disease 
than the original structure. With this contraction and absorp- 
tion, the swelling disappears, and the cure is complete. 



PHYSIOLOGICAL REMARKS. 137 

This process is always much slower when more solid parts 
are wounded, for then it is often necessary that the absorbents 
should take away the interstitial deposites of the organ before 
the cellular tissue can be left free to swell and form granula- 
tions to close the wound, — or, the neighbouring tissues must 
enlarge to a greater extent, and pour into their cells matters 
not designed by nature to appear in such situations. This dif- 
ficulty is remarkably evident in cases of compound fractures, 
where an external wound communicates with the cavity of a 
broken bone. 

Internal wounds heal in the same manner with external 
ones, but the process is then concealed from view. When the 
wound is simple, and the parts around it are not too much 
weakened by the accident to pursue a healthy course, the 
blood which fills up the intervals between its sides, and pre- 
vents them from closing, it is generally absorbed, and finally 
disappears so as to permit the sides to unite without the for- 
mation of any pus: but if the quantity of blood be very great, 
it becomes altered in character, and irritates the wound to such 
a degree that pus is secreted, and the case converted into an 
abscess. 

Even after this, the fluid may be absorbed by degrees, and 
the wound may heal by internal granulations, but far more 
frequently, nature converts it into an external wound, by an 
absorption of that side of the abscess which happens to lie 
next the surface, sometimes, even while granulations are ac- 
tually growing on the deeper side; and the abscess at length 
makes its way through the skin, pours out its contents, and 
heals in the manner already described. 

It is not by any means necessary that a part should be posi- 
tively wounded, in order that all the phenomena of heat, 
redness, swelling and pain should make their appearance, and 
that the part affected should undergo something like a repro- 
duction. Let us suppose, for instance, that a mechanical in- 
jury has been inflicted by a blow without a wound. The part 
takes on the same kind of action; there is more blood sent to- 
ward the part than usual, its sensibility is increased, &c; and 
if any particles or atoms are rendered unfit for service by the 
injury, they are taken up into the absorbents, and others are 
deposited in their place, from the capillaries, without the oc- 
currence of a rupture. 

If the injury be still slighter, the same symptoms occur, but 
they are evanescent. No change of structure takes place in 
the part, but its functions are for the moment increased in ac- 
tivity, and then every thing returns to its natural condition, as 
from a false alarm. 

None of these phenomena are inconsistent with health. They 

18 



138 PHYSIOLOGICAL REMARKS. 

do not constitute disease, but are mere exemplifications of the 
process of nutrition, by which the body was originally formed, 
and by which its waste and injuries must be repaired. When 
any disturbance takes place in the order or degree in which 
these symptoms appear, then indeed we have disease, and 
among the most important of these disturbances we may class 
inflammation^ which will be treated of hereafter. 



OF SYMPTOMATIC FEVER. 

Even where a local injury has been slight, it produces, 
through the medium of the nerves, effects upon the nervous 
centre most closely connected with the part. An increase of 
vital energy, and a larger supply of blood being indispensable 
for the repair of the injured organ, the heart is called into un- 
usual activity, and the circulation is hurried, the capillaries 
give passage to more blood in a given time, the animal heat 
is increased, and all the vital functions are carried on with un- 
usual vigour for a time, while the irritated point still holds the 
ascendant over other parts of the system in vital activity. Af- 
ter a short time, however, this unusual energy declines, from 
the exhaustion of the over-wrought organs, or the subsidence 
of the local irritation. 

It matters not whether the part injured be internal or exter- 
nal, nor whether the mischief be produced by a mechanical 
cause, by a change in the quality of the circulating fluids, or 
by some momentary derangement in the action of the nerves 
of the part, occasioning an irritation there: the same train of 
Symptoms occurs under all these circumstances, and gives us 
an example of the mildest form of Reaction or Symptomatic 
Fever. Still, the condition of the part, and that of the system 
in general, is such that nature requires no aid from art, and 
the patient can scarcely be regarded as having passed the bar- 
riers of health. 

But let the injury be a little more severe, and then disease, 
either local or general, or both, is fairly established. The part 
affected is weakened to such a degree, either by the direct ef- 
fects of the cause of injury, or by exhaustion from the excess 
of its own action, that its vessels are no longer capable of bear- 
ing up against the force of the general circulation: and al- 
though they may still permit an unusual quantity of blood to 
flow through them, this is accomplished by their passive en- 
largement, and they no longer react properly upon their con- 
tents. The current of the blood becomes less rapid, the vessels 
are more and more stretched and weakened, the colour be- 
comes deeper or more purple, and at length the fluids may he 



PHYSIOLOGICAL REMARKS. 139 

reduced almost to a state of stagnation. In the mean while, pre- 
parations for the removal and reproduction of the injured part 
may still he carried on, though laboriously and imperfectly, be- 
cause of its unhealthy condition. This is a picture of local in- 
flammation. 

Two important consequences generally follow from this state 
of things. 1st. The overloaded vessels, unable to propel their 
contents, commonly relieve themselves by effusion; that is, they 
pour out, either on the surface or within the substance of the 
part, the serum of the blood, as in blisters, — or pus, as in ab- 
scess. 2d. The distention of the vessels becomes itself a source 
of irritation to surrounding parts, and thus extends the injury 
and the disease: — while nature, on the other hand, in patients 
of healthy constitutions, as constantly endeavours to arrest the 
progress by causing an adhesion of the cells of the cellular tis- 
sue all around the inflamed parts, so as to isolate them from 
the rest of the body; and when this purpose fails, the conse- 
quences are often dreadful. 

These facts explain the appearance so commonly noticed in 
most local inflammations that are not cured in their earlier 
stages — appearances often beautifully exemplified in a common 
bile. The centre of the tumour is found soft and compressi- 
ble, being converted into a regular abscess. The parts imme- 
diately around the cyst containing the pus are of a dark pur- 
ple colour, from the stagnation of the blood in the vessels; — 
the rest of the swelling is of a bright red hue, and its tempe- 
rature is elevated far above the natural standard — while round 
the margin, the cells of the cellular tissue are obliterated by 
adhesion, and the spreading of the inflammation is prevented. 

The reader has now received some idea of the purely local 
effects of injuries when not carried to such an extent as to de- 
stroy the energies of the part, and produce its immediate or 
very speedy death by gangrene or mortification. But there 
are a series of consecutive consequences which require more 
especial notice, and by a proper explanation of these we shall 
best convey some idea of the nature of that extensive disease 
which causes directly or indirectly a large majority of all the 
deaths which load the bills of mortality — fever — a word on 
which innumerable volumes have been written, and innume- 
rable lectures delivered, causing violent altercations both in 
and out of the profession. It does not admit of a simple defi- 
nition, but must be understood from its general history. 

When a local injury is both severe and extensive, the im- 
pression upon the nervous system, in general, is such that its 
energies are depressed on the instant; for no organ or sys- 
tem in the body can endure an exceedingly powerful impres- 
sion without temporary depression from the overwhelming 



140 PHYSIOLOGICAL REMARKS. 

demands made upon it. In consequence of this depression, the 
patient is rendered languid. The hlood leaves the surface of 
the body and retires to the vital organs in the interior, embar- 
rassing them by its quantity. The heart shares in the general 
depression, and struggles feebly to continue the circulation. 
If this state of things be carried very far, the patient is said to 
be in collapse. 

More or less disposition to collapse is observable in the 
commencement of nearly every case of fever, and if carried 
beyond a certain point, the vital organs are paralyzed, and the 
patient generally dies in a few hours — as often happens in the 
Asiatic cholera, and sometimes in malignant intermittent fe- 
vers; — but otherwise, it seldom continues long. The nerves 
appear to be accumulating power during this short period of 
repose; and, before long, reaction, or symptomatic fever, makes 
its appearance. The heart acts with continually increasing 
energy, driving the blood in a very rapid torrent through the 
arteries. 

Still, the injured part itself, demands and receives the great- 
est supply of nervous energy and the largest amount of blood, 
for it is there that nature is compelled to resist or repair the 
threatened mischief. This part, already weakened to a degree 
which makes the pressure of even a healthy circulation dan- 
gerous to its integrity, suffers incalculably more under this 
violent reaction of the system. Hence the necessity of de- 
pleting measures, such as bleeding, cold effusions, &c, in cases 
of high inflammatory fever in its first stage. 

But it is a law of the animal economy, as we have had occa- 
sion to mention in the earlier part of the work, that whenever 
an organ is called upon for unusual exertion, it afterwards 
sinks into a state of exhaustion; or its vital powers are dimi- 
nished. This state of things, as it appears in the injured part, 
has been already pointed out, but its influence on the system, 
generally, remains to be explained. 

When the principal blood vessels, and the heart itself be- 
come fatigued to a certain degree, the paroxysm of fever de- 
clines: but if the local irritation continues the same, or when 
it gradually increases in violence, the heart and vessels, after 
a temporary and partial rest, are stimulated to renew their ef- 
forts, and this alternation may be continued from day to day, 
while the patient improves, or becomes worse, in proportion 
to the relative length and intensity of the remissions and ex- 
acerbations. Here, then, we have explained the phenomena 
of a remittent fever, and indeed, all fevers are more or less 
remittent. 

It has been stated that in order to produce reaction, or 
symptomatic fever, it is necessary that the local irritation 



PHYSIOLOGICAL REMARKS. 141 

should be of sufficient extent and severity. Now, the part af- 
fected with inflammation is liable to the same alternations of 
increased excitement and exhaustion that mark the progress 
of a general fever; for inflammation is but a kind of local fe- 
ver, and of course it is subject to its remissions. When the 
remission of the local symptoms is so complete that the irrita- 
tion falls below that standard of violence which is necessary 
to produce reaction, the symptomatic fever must cease; but it 
will be renewed again as soon as the local exacerbation reaches 
the requisite degree of intensity. It is obvious, that, under 
such circumstances, we should have an intermittent fever. 

All the three forms of fever, or types, namely, the conti- 
nued, the remittent, and the intermittent, are occasionally seen 
as consequences of simple mechanical injuries, and the reign- 
ing doctrine of the day, (the Broussaisan,) attributes, very 
correctly, all fevers to some local irritation. It was formerly 
customary with nosologists, (that is, those who divide diseases 
into orders, genera, and species, like objects of Natural His- 
tory,) to range fevers under two distinct orders, the idiopa- 
thic, or self-created, and the symptomatic, or consecutive fe- 
vers. 

This distinction is now very generally discarded, and we 
think with perfect propriety; for in the train of symptoms 
which mark the approach and the attack of fever, there is al- 
ways found some local inflammation, or some irritation of suf- 
ficient extent or violence, to deserve that name; and this local 
affection invariably precedes the reaction. It is rarely possi- 
ble, in the present state of our knowledge, to penetrate farther 
back than this primary local affection in studying the history 
of fevers, and it is therefore styled the cause, or the proxi- 
mate cause of fever. In that sense we shall employ these 
terms in our future remarks in the progress of this work. 

The proximate cause of fever is generally the result of some 
accident, such as a blow or fall, improper diet, exposures to 
changes of climate, an irregularity in the functions of some 
nerve produced by some known or unknown causes, the ab- 
sorption and introduction into the circulation of some poison, 
the inhalation of noxious vapours, &c. &c. These are called 
exciting causes. 

There are peculiarities of certain individuals, the result of 
accident, hereditary tendencies, &c, which prevent them from 
experiencing the same effect which most persons suffer from 
the action of the same causes of disease. These peculiarities 
are commonly styled constitutional, and are designated among 
medical men by the terms temperament , diathesis, idiosyn- 
cracy, &c, — hard names that we shall not even attempt to ex- 
plain, — for this work is not intended for those who wish to 



142 PHYSIOLOGICAL REMARKS. 

study the science in all its elaborate details. Again, there are 
certain atmospheric or other occult influences which modify 
the character of fevers in different places, years, and seasons. 
Thus, the same imprudence in eating, which in one year pro- 
duces a bilious fever, shall, in another, bring on a yellow fe- 
ver; in a third, malignant cholera; in a fourth, a spotted fe- 
ver, &c. &c. Causes of this description are entitled predis- 
posing causes. 

The same changes produced in the characters of fever by 
the various predisposing causes, are equally obvious in the his- 
tory of local inflammations. Thus, an amputated limb shall 
recover without difficulty, and very promptly at the Pennsyl- 
vania Hospital, in Philadelphia, while at St. Thomas's, in Lon- 
don, it shall bring on an erysipelas of the member; and at the 
Hotel Dieu, in Paris, the patient shall die of abscess of the 
lungs — though all the individuals subjected to'these operations 
may resemble each other in apparent health, and be subjected 
to a plan of treatment alike in every instance. Nay, more, — 
in a succeeding year, the order of these results in the different 
institutions mentioned, may be entirely reversed. 

So far we have been treating of fever in its simplest form, 
but it is now time to mention other results and trains of symp- 
toms which may render the disease extremely complex and 
difficult to be understood. In explanation of our meaning, it 
is, perhaps, most proper to select an example from among those 
of the most involved character. We will select the case of an 
irritation in the intestines. A patient predisposed to abdomi- 
nal disease, either in consequence of some personal peculiari- 
ty, or the epidemic tendency of the season, shall be guilty of 
an imprudent exposure, or an irregularity of diet. An irrita- 
tion shall occur in consequence of this conduct in some part 
of the small intestines. These organs are supplied by the 
nerves of organic life, and consequently the brain takes no no- 
tice of what passes there until the mischief becomes severe. 
The part affected, perhaps previously weakened by the epide- 
mic or other tendency, or by ill-regulated habits, is unable to 
resist the vigour of the general circulation, bearing with unu- 
sual energy upon this particular spot, in consequence of the 
urgent necessity of repairing, with the utmost speed, the inju- 
ries inflicted upon such important organs. The part inflames; 
the heart is called into undue action, and the functions of the 
intestines are embarrassed or overwhelmed. Still, the exist- 
ing condition of things is not as plainly perceivable as it is 
when external parts are injured, for the general circulation is 
less obviously disturbed when the disease is confined to or- 
gans of which the vessels appertain to the portal system, (sec 
page 89 7 ) which is compared, in our earlier pages, to a para- 



PHYSIOLOGICAL REMARKS. 143 

sitic plant, than when it affects, directly, the great arterial tree. 
The concentration of the vital powers upon the internal or- 
gans, resulting from their excessive irritation, render the ex- 
ternal parts and other organs comparatively languid, and there 
is established a low, irregular fever, very different from that 
which characterizes external injuries. The countenance, and 
the skin in general, do not exhibit the strong marks of fulness 
that occur in ordinary fevers; for the blood is mainly direct- 
ed to the viscera, and the natural impression that the disease 
results from general debility, is often impressed upon other 
minds than those of the uninitiated. The unresisted accumu- 
lation of blood in the bowels, soon produces an embarrassment 
of the circulation, and the vessels soon endeavour to relieve 
themselves by pouring out increased and vitiated secretions 
internally, even while the external surface is hot and dry, and 
the insensible perspiration is checked. The patient becomes 
affected with a dysenteric discharge. 

The impression made upon the nerves of the part by this 
extreme and increasing irritation is conveyed to the great 
nervous centres of animal life, and all the most important func- 
tions are necessarily disturbed by this consecutive result. The 
several ganglions may be called on for a degree of exertion 
inconsistent with their healthful action, and each of these may 
become a new centre of irritation, calling for additional exer- 
tions on the part of the heart and great vessels, already debi- 
litated by previous demands. If the disease advances, the ir- 
ritation at length radiates from the ganglions to the spinal 
marrow, and the nerves of animal life become involved in the 
disease. Muscular power and the external senses are then 
embarrassed, and the general disturbance is at last continued to 
the brain itself, — low, muttering delirium comes on; the or- 
gans of respiration become affected; twitchings of the tendons, 
a ghastly countenance, spasms and insensibility make their 
appearance, and unless the superior powers of the constitution, 
with the aid of high professional skill and tact, enable the pa- 
tient to conquer the disease, he dies! In the mean while, 
though every symptom seems to mark the presence of debili- 
ty, the inflammation cf the part of the small intestines which 
causes this long train of evils, goes on continually increasing, 
even to mortification, and the several centres toward which 
the irritation has been radiated — themselves, in turn, inflame; 
so that, instead of a single local injury, we have to contend 
with many, all of which are important and dangerous to life. 

The professional reader would at once perceive, in the fore- 
going picture, the likeness of a disease formerly ranked among 
the most purely idiopathic fevers, but now well known to ori- 



144 PHYSIOLOGICAL REMARKS. 

ginate in an inflammation of certain little glands upon the mu- 
cous membrane of the small intestines! 

This disposition displayed by irritations, to radiate by means 
of the nervous connexions existing between different parts, 
explain a host of singular effects observed in the history of 
disease, — Such, for instance, as the following: — A blow on the 
head will sometimes occasion an abscess of the liver, and an 
inflammation of the liver will produce disease of the brain. 
A disturbance of the bowels will give rise to an eruptive dis- 
ease of the skin, and an eruption on the skin will produce an 
injurious influence on digestion. Some irritations of the small 
intestines give rise to cramps of the extremities, and a broken 
limb is a very common cause of little scattered abscesses in 
the lungs. In the midst of all these endless complications, 
how absurd appear the pretences of those innocent empyrics 
who unhesitatingly attack diseases of which they cannot com- 
prehend the seat, by means of remedies of which they neither 
know the nature or the action! 

The general debility noticed in the more severe and com- 
plicated fevers, is not entirely the result of exhaustion of the 
system from over action: it frequently appears from the first 
moment of the attack, and is produced by the concentration 
of vital energy in the irritated parts, which does not leave 
enough for the proper supply of the other organs. But it is 
well known that the mere extent of surface affected by an ir- 
ritation, has quite as much influence as its severity in deter- 
mining its physiological effects; for a very slight scald over 
the whole surface of the skin will kill; while a "hand or a foot 
may be burned to cinders in a furnace without endangering 
the life of the owner. The two facts just noticed enable us to 
employ, advantageously in medical practice, certain powerful- 
ly stimulating applications to healthy parts in order to lessen 
the intensity of violent morbid actions in other portions of the 
body. This is called treatment by counter irritation. Let 
us take an example: — A patient, with a strong determination 
of blood to the head, growing, perhaps, out of over application 
of the mind. He has a severe headach and confusion of ideas, 
with some disorder of the stomach produced consecutively, 
and complains of nausea, vertigo, noises in the head, and an 
extreme sensibility of the eye and ear. His physician orders 
him large mustard plasters to the wrists and ankles, and con- 
tinues them until considerable irritation is produced. The 
head is relieved, and in the following manner: — The injury 
inflicted by the remedy is mild in grade, but covers a consi- 
derable surface. It does not endanger the integrity of the 
part, yet it calls off a great deal of vital energv from the svs- 



PHYSIOLOGICAL REMARKS. 145 

tern in general, and the diseased organ, which in the case de- 
lineated, is the brain, shares in the diminution until, perhaps, 
its over excitement is reduced to the standard of health, and 
it is permitted to recover its energies and powers of resistance 
before nature has accomplished the cure of the inflammation 
caused by the mustard. 

Drastic purgatives and other internal remedies of a highly 
stimulating character, are often employed in fevers and local 
inflammations, upon this principle of counter irritation; and 
there are cases in which the happiest results may follow such 
a course; but this mode of treatment has been carried much 
too far by the practitioners of the last age. 

There are two important precautions which should always 
be observed in practising by counter-irritation. 1st. Strong 
stimulants should never be administered or applied during the 
height of reaction in fevers, because their direct effect in in- 
flicting a new injury increases the violence of reaction, and 
must necessarily render the subsequent exhaustion more se- 
vere. If used at all in fevers, they should be employed during 
the remissions or intermissions. An exception to this rule 
exists in certain cases of low or typhoid fevers of long stand- 
ing, — when dire necessity compels us un willingly to support 
the sinking energies of nature at all hazards. But in these 
cases, the end in view is general stimulation, and not counter- 
irritation. 2d. Strong Stimulants, applied externally, should 
uever be carried to such an extent as to cause severe pain in 
cases of disease of the head, for the radiation of the irritation 
caused by the remedy to the other extremity of the nerves of 
the part may produce an inflammation, or an increase of the 
functional embarrassment in the brain! 

The reader will now perceive that any local injury of con- 
siderable extent, and of sufficient intensity to produce a mor- 
bid change in the actions of the injured part, must generally 
produce a reaction of the circulation; or, in other words, a fe- 
ver. On the other hand, every case of fever commences in 
some local irritation, which, in most instances, gives rise to 
other irritations in distant parts. The first of these affections, 
which has been already defined to be the cause or proximate 
cause of the attack, is called the primary irritation; the others 
are styled secondary or symptomatic. But it is a singular fact 
that the primary and secondary affections mutually act on each 
other in most cases, so that when either of them is exacerbated 
or relieved in any degree, the other shares in this change of 
intensity. Thus, if primary irritation of the stomach occasions 
the symptoms of mental excitement which was described on 
the last page, and the patient should venture to increase the 
disorder of the head, by applying his mind to serious thought, 

19 



146 PHYSIOLOGICAL REMARKS. 

his stomach would inevitably be rendered worse; and if a blow 
on the head should produce an inflammation of the liver, an 
active course of depletory treatment, addressed to the latter, 
would materially lessen the danger of the brain. This explains 
the reason why so much of our practice in medicine is direct- 
ed to the mitigation of symptoms, instead of the destruction of 
the cause of the disease. 

The removal of the proximate cause of a disease does not 
always produce a cure; for, on many occasions, the former is 
successfully combatted by the power of nature, while the se- 
condary irritations perpetuate the disease. Thus, an irritation 
of the spine may produce disease of the heart, and the latter 
may destroy life long after the former has yielded to remedial 
measures. 

When the symptomatic irritation is much more intense than 
the primary one, it sometimes acts as a natural counter-irritant, 
and the latter suddenly and entirely disappears, the former 
having called off all the surplus vital energy to itself. This is 
an instance of what is called, by physicans, Metastasis. 

Metastasis generally takes place from parts of lesser to those 
of greater consequence in the economy; and as the affection 
is of much more pressing importance than its cause, it is often 
proper to endeavour to reproduce the original affection by 
means of appropriate remedies; and if we succeed, the secon- 
dary irritation commonly subsides as suddenly as it appeared! 
I remember the case of a lad who laboured under a disgusting 
disease of the scalp, which disappeared by metastasis, on five 
or six occasions, always producing furious insanity. The mad- 
ness resisted every species of treatment until the eruption was 
reproduced, when he became rational immediately. Such ac- 
cidents as this are common in most of the eruptive diseases, 
when they are arrested by improper exposures, or too energetic 
local treatment: — the eruption declines, and some vital organ 
becomes the seat of a dangerous and often fatal inflammation. 
To such cases of metastasis, produced by external causes, the 
term revulsion has been applied, though it is frequently em- 
ployed in a more extended sense. 

There is reason to believe that in most cases of revulsion, 
there exists a previous radiated irritation in the spot to which 
the disease is translated, but that this is mild, and masked, as 
it were, by the more obvious external affection. When the 
latter is suppressed too suddenly, it is easy to comprehend 
that the vital energy previously concentrated upon it, may not 
become regularly and safely diffused through the system; but 
may be suddenly directed upon the previously weakened in- 
ternal organ, in such a manner as to produce the singular phe- 
nomena of metastasis. 



PHYSIOLOGICAL REMARKS. 147 

The number of instances of serious disease, occasioned by 
the principle on which metastasis depends, is much greater 
than might be supposed at first sight; for it includes not only 
the revulsions of which we have been speaking, but all the 
evils following the sudden arrest of habitual discharges — such 
as apoplexy from the cure of piles, abscess of the lungs from 
the healing of fistula, convulsions and inflammation of the bow- 
els from exposure in young females, &c. : in all which cases 
it is desirable, under ordinary circumstances, to renew the ori- 
ginal affection, the suppression of which has caused the mis- 
chief; and where this cannot be done, it is often advisable to 
imitate nature, by establishing a similar local disease in some 
more convenient place, as is often done by means of issues, 
setons, moxa, and tartar emetic plasters. 



OF IRRITATION AND HYPERNUTRITIOX. 

I have now described, in a general way, both the primary 
and secondary effects of the function of nutrition, as displayed 
in the reproduction of parts, and have shown how disease in- 
evitably follows the over-strained efforts of nature to produce 
a cure of injuries, whether the causes be internal or external. 
Let us now pass to the consideration of some of the conse- 
quences of increased vital activity in particular parts, when 
no apparent injury has been inflicted; consequences resulting 
from some inexplicable changes in the action of the tissues 
themselves, but probably produced by irregularities in the 
nervous influence, which, when properly balanced, preserves 
that mutual relation of parts so necessary to the proper sup- 
port and sustenance of all the various organs of an animal so 
complex in structure as is man. 

Under the operation of certain stimulants, and especially 
under the natural stimulus of exercise, any part or organ of 
the body may have its functions increased; and even its struc- 
tural development is hastened by the continued action of such 
causes. The growth of muscles, under such circumstances, 
has been already mentioned, and this subject will claim addi- 
tional attention in the chapter on Hygiene. To quote ano- 
ther and more curious example of the operation of this law, it 
may be mentioned that habits of thought and study not only 
strengthen the powers of the mind, but actually enlarge the 
brain. This state of things is perfectly consistent with health, 
though occasionally, when carried very far, it produces peculi- 
arities verging on, and predisposing to, disease. Thus the 
constant employment of certain muscles produces those pecu- 
liarities of person, or slight deformities which characterize the 



_ 



14S PHYSIOLOGICAL REMARKS. 

operatives in particular trades; and the habitual cultivation of 
certain instincts, moral feelings, or intellectual faculties, may 
occasion ungovernable passions, morbid feelings, or eccentri- 
cities of character. 

It is still more curious that the same plan of counter irrita- 
tion, which was spoken of in the last section, as a mode of treat- 
ing fevers or inflammations, may be usefully employed in cor- 
recting the undue effects of the functional exercise of particu- 
lar organs. Thus, the prescription of powerful and continued 
muscular exertion corrects the ill consequences of laborious 
study, and an application to the solution of mathematical stu- 
dy, has been known to cure muscular spasms! 
• But there are numerous changes of structure of a decidedly 
morbid character, yet somewhat of the same, nature with those 
just pointed out. These are called instances of hypernutrition, 
and are marked by an undue growth of the part affected, of 
such extent, as to embarrass some of its functions. This growth 
is the result of a chronic or habitual increase of the vital ener- 
gy of the part, to a degree inconsistent with health; but not 
distinctly marked by those changes in colour, temperature, 
and sensibility, which distinguish the process by which inju- 
ries are repaired, nor by those symptoms of fever that present 
themselves during the reaction consequent upon such inju- 
ries. 

Hypernutrition almost invariably consists in an increase of 
the interstitial deposites of the tissue interested, and rarely 
leads to any great addition to the cellular or primitive tissue. 
It is considered as a result of one of the lightest shades of or- 
ganic irritation, which latter term we shall not attempt to 
explain at full length; for it is extremely difficult to say in 
what acceptation it is received by the profession at larg< 
various and, apparently, inconsistent are the phenomena attri- 
buted by different theorists, to this very general term. In 
few words, it may be defined to be a morbid increase of vitali- 
ty in some particular organ, tissue, or system, not sufficient in 
degree or extent to constitute an inflammation. 

As the principal effect of hypernutrition is the unnatural in- 
crease of the interstitial matter distending the cells of the cel- 
lular membrane in the different compound tissues, it may be 
fairly said to include the unnatural increase of the serum which 
lubricates the cells of the free or general cellular tissue itself, 
and also the serous cavities, whenever this accumulation is the 
result of increased vitality in the part. 

Dropsy, whether general or local, is commonly a conse- 
quence either of a merely mechanical obstacle to the free cir- 
culation of the blood, or of a similar difficulty caused bv a 
change in structure in some highly important organ, — the 



PHYSIOLOGICAL REMARKS. 149 

dropsy being, in fact, a symptom of some other much more 
serious accident, or disease; and until the latter is removed it 
is in vain to attempt the cure of the former. 

It may seem strange that we should rank dropsy among the 
diseases of increased action, when it is so universally consi- 
dered as a mark of debility; but it does not follow by any 
means, because a particular portion of the body is acting with 
undue force, that the system in general should be found in 
a similar condition. The reverse of this is more frequent- 
ly the case, and general debility often acts as an exciting cause 
of local activity. The functions of the free cellular tissue, and 
of those parts which are most liberally supplied with this tis- 
sue, appear to increase as the powers of animal life decline, and 
they continue in certain instances even after the death of the 
individual! As persons decline in life, or become weakened 
by disease, the more dependent portions of the body begin to 
display a tendency to dropsical effusion, and the extent of this 
disposition increases as the powers of the system diminish. 
Perspiration is one of the last lingering operations of life, and 
even after the body has been laid in its final receptacle, the 
hair and the nails may continue to grow! It would seem that 
those portions of the most complex animals which resemble 
in structure the bodies of the simplest animalcules possess 
some power analagous to that by which the latter preserve 
their vitality when dried and laid aside for years! 

But the cellular tissue is the seat of numerous other changes 
of structure more obviously the result of hypernutrition, com- 
plicated, perhaps, with some change in the nervous balance of 
the part, by which the operations of the tissue are modified, 
and the deposites altered in character from that of serous ef- 
fusion. One of the most usual examples of this is found in 
the formation of cavities or sacks distended with fatty, gase- 
ous, or gelatinous matter, and constituting tumours which go 
on increasing until removed by the knife or remedied by other 
measures. The changes appear to be effected without calling 
the capillary blood vessels into any undue action; and may 
even be arrested and removed by measures which increase the 
degree of irritation in the part, and promote the rapidity of 
capillary circulation. Thus, if the cavity of a gelatinous cel- 
lular tumour be laid open with a knife, and its contents be 
evacuated, it becomes so much excited by the injury, that its 
cavity is often obliterated by adhesion, and its peculiar secre- 
tion disappears. Again, if a wen be repeatedly rubbed every 
day with a saturated solution of common salt, it will frequent- 
ly inflame, become gangrenous and slough away, through nu- 
merous little holes in the skin; and the disease will be found 
perfectly cured. 



150 PHYSIOLOGICAL REMARKS. 

Among the parts of the body which are more purely cellu- 
lar in their structure — the skin, is peculiarly liable to hyper- 
nutrition. It is seen, generally, in elephantiasis, and locally, 
in corns and various excrescences. The causes of the latter 
tumours are often purely mechanical. 

In the locomotive apparatus, such consequences of irritation 
are less frequent, but they are seen occasionally in the knotty 
enlargements of tendons produced by local pressure, and in 
the nodes and other swellings of the bones. 

Hypernutrition of the hollow viscera, is not at all uncom- 
mon. It is seen in the heart, from spinal irritation; in the sto- 
mach, from over-eating; and still more commonly from the 
habit of taking inordinate quantities of fluid; and in the blad- 
der, from obstructions to the discharge of urine in stricture, 
gravel, (fee. 

In compound organs, such as the bones, for Instance, the ex- 
cess of nutrition may be confined to any one of the several in- 
gredients of which those organs are composed. Thus, in some 
cases the quantity of animal matter is increased, and the bones 
become so soft as to bend under the action of the superincum- 
bent weight of the body, constituting what is called mollities 
ossium, and giving rise, in childhood, to bandy-legs, and even 
elub-feet. In other cases, the quantity of earthy matter is 
thrown down in undue amount, and the bones are rendered so 
brittle as to break under slight muscular exertions, consti- 
tuting the disease termed fragilitas ossium. It is often diffi- 
cult to determine whether these changes result from an in- 
creased supply of one ingredient, or a diminished secretion of 
the others; and it is sometimes of great importance to distin- 
guish between these two conditions, for, in the former, there 
is always an undue degree of vital activity in the part affected, 
while, in the latter, the cause of the change of structure is 
more frequently an irritation in some distant organ or system 
which calls off the vital power in another direction, and thus 
induces a symptomatic and secondary debility of that part. 
Under circumstances so opposite in character, it is obvious 
that very different courses of treatment may be required. 

In the foregoing remarks, we have considered hypernutri- 
tion as the result of modifications in the transmitting power of 
the tissues, to which, in a previous section, the function of nu- 
trition has been attributed. But it is obvious that the condi- 
tion of the vessels, and the circulating fluids, must exert an 
important influence upon the effects of irritation in producing 
these alterations of structure, as upon them depends the quan- 
tity and quality of the material furnished to the parts inte- 
rested. 

It is also obvious that the action of the nerves is equallv 



PHYSIOLOGICAL REMARKS. 151 

engaged in the process; for, independently of the control over 
the operations of the tissues, exercised directly by these con- 
necting wires of the animal machine, (see page 130,) the mu- 
tual association between the nervous energy and vascular ac- 
tivity is so intimate and constant, that it is impossible for either 
to be increased or diminished without a corresponding altera- 
tion in the other. It is impossible, however, to prosecute this 
subject farther on the present occasion. 

The application of general principles to the treatment of dis- 
eases resulting from hypernutrition, is by no means difficult. 
The remedies are of two classes. 1st. Those addressed to the 
part affected; and 2d. Those intended to act on distant parts, 
or upon the system generally. Among the former class we 
may place mechanical pressure at the head of the list, when- 
ever it is applicable. This remedy acts by diminishing the 
quantity of the circulating fluid supplied to the part; it resists 
the deposition of new matter, and it encourages the absorption 
of the surplus particles which have resulted from the disease. 
In all these ways it tends directly to remove the evil. Pres- 
sure also benumbs the sensibility of the nerves, and thus les- 
sens the vital activity. Unfortunately, this remedy is applica- 
ble only in cases of external disease; and when these are cha- 
racterized by a high state of nervous excitement, the pressure 
cannot be tolerated. 

Next in order, we may rank absolute rest of the part, by 
which we mean not only mechanical rest, but also, rest of the 
functiojis of the part. Suppose the eye or ear, for instance, 
to be the seat of an organic irritation, tending to produce a 
hypernutrition of any portion of the organ, it is just as neces- 
sary to prevent the patient from exposure to light or sound, 
and to cause him to avoid the exercises of leaping or running, 
so as to agitate the fluids and quicken the circulation; for, 
whatever induces the exercise of an organ has a tendency to 
increase its vital activity, and especially its nutrition. 

Cold applications, and other sedatives, are also among the 
very important remedies; but, as these always induce a reac- 
tion, unless their application is continued for a considerable 
time, it is productive of more injury than benefit to use them 
partially or timidly. Their action is very similar to that of 
pressure, and their applicability is even more extensive. 

Local depletion follows next. The action of cups and 
leeches is this. They remove from the blood vessels in the 
neighbourhood of the part, a portion of their surplus supply of 
blood, and, at the same time, they diminish the whole amount 
of the circulating fluid,— but the wounds and the iritation di- 
rectly resulting from the bites of the leeches, or the blades of 
the scarificator, determine an additional flow of blood toward 



152 PHYSIOLOGICAL REMARKS. 

the part. If the quantity abstracted be large, the local ner- 
vous excitement is lessened, the morbid sensibility of the 
nerves is relieved, and the capillaries are allowed time to re- 
tract and recover their energies; but, if it be small, the effects 
of the additional irritation, produced by the remedy, may 
more than counterbalance the benefit derived from it, and the 
disease may be rendered worse, instead of better. As hyper- 
nutrition is commonly the result of chronic and tedious affec- 
tions, local depletion cannot be carried so far in complaints of 
this nature as it can in cases of decided and severe inflamma- 
tion, and it is therefore less frequently applicable in the for- 
mer than in the latter class of morbid actions. Yet it is fre- 
quently employed with a happy effect. 

Stimulating applications are rarely proper, because their 
immediate effect is to concentrate additional vital force in the 
parts to which they are applied. But it is found that the results 
of irregular hypernutrition possess a less perfect organization, 
and are less capable of resisting destructive agents than the 
healthy portions of the body. Stimulating applications are, 
therefore, occasionally useful in producing inflammation in the 
newly formed parts; by which means they are actually destroyed 
and caused to slough away, as is frequently the case with su- 
perficial wens and fatty tumours, particularly such as are so 
frequently observed upon the head, in persons who have passed 
middle life. This is a mode of treatment, employed more in 
condescension to the fears of the patient, than to the proper 
laws of the science, for the remedy is quite as painful, and cer- 
tainly more dangerous than the knife, when the latter is pro- 
perly employed. 

The action of the two last mentioned remedies will explain 
to the popular reader a fact which puzzles many; namely, that 
two different plans of treatment, diametrically opposed to each 
other, may sometimes prove equally successful in the cure of 
the same disease! 

The general remedies which are applicable in cases of hy- 
pernutrition, may be again subdivided into evacuunts, coun- 
ter-irritants, and tonics. The former are employed when 
the patient is in high health or plethoric. They act on the 
disease by diminishing the force and quantity of the circula- 
tion; and some of them, like the drastic purgatives, may ulso 
prove advantageous by counter-irritation. 

The regular counter-irritants, such as issues, setons, moxa, 
blisters, &c, are frequently serviceable in the manner already 
pointed out in the section on fever. They must be employed 
mildly and for a long period of time, to produce much advan- 
tage in cases of hypernutrition. 

Tonics are used in many cases where the disease occurs in 



PHYSIOLOGICAL REMARKS. 153 

persons of weakly or exhausted constitutions, and it is quite 
possible for this condition to be produced by the disease itself, 
notwithstanding the slight degree of irritation commonly ob- 
served in such cases; for, when the organ affected is a vital 
one, the embarrassment of its functions alone, may cause a ge- 
neral disturbance sufficient to sap the energies of the whole 
system. This is proved by the history of many instances of 
hypertrophy of the heart and liver. The mode in which to- 
nics act beneficially is this: they strengthen and elevate the 
tone of all parts of the body so as to restore them to their na- 
tural energy. In accomplishing this purpose, they undoubtedly 
tend to stimulate the seat of the morbid irritation, in common 
with all other parts; but the increase of vital action, and the 
regulation of the balance of excitement in the organs, general- 
ly, lends still more powerfully to depress that morbid irrita- 
tion by calling the vital powers into play in other quarters. 

Besides the classes of medicines already noticed, there are 
several other agents employed in practice with very great 
effect, but of which the mode of action does not admit an 
easy explanation. They are principally prescribed in those 
forms of hypernutrition which appear in the bones, glands, and 
other complex organs, and in those which are the result of 
what are ordinarily called specific diseases. These remedies 
have a most powerful action in promoting absorption, but how, 
we know not. Among them we may notice calomel, and 
arsenic, in glandular swellings and the nodes of bones and pe- 
riosteum; colchicum in gout, and iodine in tumours, of almost 
every description. 



OF CAPILLARY IRRITATION— INFLAMMATION. 

Having dismissed the subject of irritation, as displayed in 
modifications of the transmitting power of the tissues, it is pro- 
per to follow up the inquiry by speaking of the effects of irri- 
tation on the capillary circulation; but so much has been al- 
ready advanced on the subject, in the section on mechanical 
injuries, that our task will be a light one. 

It has been seen that the first object of nature, on the occur- 
rence of an injury, or an undue excitement of a part, is the re- 
pair of the part. To accomplish this end, she directs toward 
the part an increased amount of nervous energy, and enlarges 
the capillaries to facilitate the freedom of circulation in the 
injured spot. She goes still farther when the case is a grave 
one, for she enlarges all the principal arteries going toward 
the injury, contracts all those leading to a distance from it, 

20 



154 PHYSIOLOGICAL REMARKS. 

and then calls the heart into violent action to increase the ra- 
pidity of the flow of blood. 

The term irritation has been so constantly applied in very 
recent times, to this peculiar condition of an injured part, that 
the idea of irritation is inseparably, though unfortunately, as- 
sociated with the idea of an increased capillary circulation; — 
one of many effects being thus substituted for a cause; — and 
the whole group of associated phenomena involved in the 
healthful operation of repairing injuries has been set down as 
a disease! Hence all the interminable attempts to define the 
words irritation and inflammation, and the long shelf-loads 
of volumes written on the vexed question, whether the latter 
is a disease of excitement or debility! 

The term capillary irritation, simply considered, ought to 
be confined to the designation of that condition of the capilla- 
ries which attends upon the sanitive operations of nature in 
removing injured, and in restoring lost parts.' When the 
parts become exhausted by such efforts, and no longer capable 
of resisting properly the impulse of the blood, so that the very 
attempts at cure become a source of disease, the condition of 
things is changed, and the terms should be changed also. 

The reader will now be able to comprehend the motive 
which induces us to discard the word irritation in the sense in 
which it is employed by the founder of the popular medical 
doctrine of the day, and to employ, instead thereof, the word 
inflammation, confining the meaning of the latter to condi- 
tions which are decidedly morbid. 

Much of what we have to remark upon the subject of in- 
flammation has been given to the reader in the section on the 
reproduction of parts, and in that upon reaction. All that we 
propose at present, is to recall to mind the fact that the diffe- 
rent parts concerned in an inflammatory action may be in very 

* Much has been written, and some ill feeling- has been displayed bv physi- 
ologists, on the question of the primary effects of irritants on the capillaries; 
some asserting that they contract, others, that they dilate them. And the con- 
tending parties regulate their ideas of the active or the passive nature of inflam- 
mation accordingly. Now this is really illogical. Inflammation is not a direct, 
but a consecutive effect of the application of irritants. Some irritants do cer- 
tainly contract parts— as the astringents,- others as certainly expand them— as 
heat,- and both, alike, occasion inflammation, though neither of these changes 
just noticed constitute the disease. Two things are certain— inflammation is 
always attended with enlargement of the capillaries, and enlargement of the ca- 
pillaries is always attended with relaxation of the arched fibres of the middle 
coat. This is no proof that inflammation is a state of increased, or that it is a 
result of diminished action. The relaxation may be, like many other similar 
phenomena, a mere result of a natural consent of parts consistent with either 
theory. If these facts had been duly considered by phvsiologists, a deal of ink 
and paper would have been saved. 



PHYSIOLOGICAL REMARKS. 155 

different conditions, requiring the application of various and 
opposite remedies. This is done in order to show the fallacy 
of the idea entertained by many followers of Broussais, that 
the local application of stimulants to internal parts in a state 
of inflammation, or as they term it, irritation, is always im- 
proper. This conclusion they would hardly attempt to defend 
to the fullest extent in theory, but it is obviously the princi- 
ple on which they practise in fevers 

Let us take the case of a common bile, in a state approaching 
to maturity, — a case which has been described already in a 
previous section. The walls of the centre of the tumour are 
purple, engorged, and display marked feebleness of action. 
The circulation is here very inactive, or it is completely ar- 
rested; and the sensibility of the part is diminished. Apply 
stimulants to this part, and you will hasten the opening of the 
abscess; nor will even the use of powerful caustics occasion 
material pain, or heighten, in the slightest degree, the violence 
of the disease. The middle of the tumour is often in a state 
of high irritation, occasioning increased deposition, and hard- 
ening, analogous to a rapid hypernutrition. Stimulants would 
here be highly improper, and an active depletion may be, 
sometimes, very serviceable. Around the outside of the tu- 
mour the healthful process of adhesion, or the preliminary 
steps of the function of reproduction, are going on regularly, 
and should not be disturbed. Generally, reaction is aiding the 
proper progress of the case, or, from defects of constitution, the 
action of the heart may be too violent, or too feeble, for the 
purpose — and the general treatment must be varied according 
to these circumstances. 

The mere extent of an inflammation may determine the pro- 
priety of using or avoiding stimulants in the treatment. Let 
us choose an example from the history of an accident familiar 
to all. A man shall burn his finger severely, and one of his 
elderly advisers who has heard that spirits of turpentine is 
u good for a burn," shall apply this formidable article to the 
finger: — the patient will soon be convinced by bitter experi- 
ence that the doctrine is incorrect! But hasty conclusions are 
seldom safe. Another patient shall fall into a hatter's caldron, 
and the whole of his lower extremities shall be deeply and 
terribly scalded. Pale, and shivering in collapse, he is car- 
ried to an hospital, and the surgeon shall envelop his limbs in 
an ointment composed of lard and spirits of turpentine. Af- 
ter a tedious confinement, the patient may recover, telling me, 
"the sovereignest thing on earth, was turpentine" for an ex- 
tensive burn!* 

* I was once present when a little black boy was brought into the Pennsyl- 
vania Hospital in a violent frenzy. He had burned his eyes while playing- with 



156 PHTSIOLOGICAL REMARKS. 

If we apply the same reasonings to the treatment of internal 
injuries, which habitually govern us in the treatment of exter- 
nal complaints, (which is indeed the only philosophical plan 
of procedure,) we shall find the use of stimulants in fever, 
when properly applied, quite as reasonable as that of turpen- 
tine in burns. 

Let us suppose a patient to be attacked with that species of 
inflammation in the intestinal glands which gives rise to ty- 
phus fever. If we give the patient wine in the early stages 
of this complaint, we do exceedingly wrong under all ordina- 
ry circumstances, for the inflammation is of small extent. True 
we do not give pain to the patient, for the nerves of the part 
affected are those of organic life. The old-fashioned plan of 
stimulating in typhus, has slain more men than Samson! Yet 
when, in the after progress of the disease, the radiating irrita- 
tions have extended the inflammatory action to many other 
organs, and when the powers of the system sink beneath the 
unequal struggle, wine may prove not only useful but essen- 
tial to the life of the patient! 

But let us now choose a case of a different character. A 
patient appears in the first stage of malignant cholera. The 
whole surface of thirty-six feet of intestine are in a state of 
sudden and high irritation! He is in profound collapse, and 
the superficial circulation is totally arrested! The case resem- 
bles that of the extensive scald. Give him largely of brandy 
and opium, and he may recover. Treat him on an opposite 
system, and he dies! 

How ridiculous, then, is that system which prescribes for the 
name of a disease, while it neglects the state of that disease! 
Even in cholera, of which we have just spoken, if stimulants 
were given in every case, the most serious evils would follow, 
particularly in temperate climates, where the sudden and pro- 
found collapse which marks its access in tropical countries is 
very rarely witnessed. 

The treatment of inflammation should be governed by the 
same principles, and requires the use of the same classes of 
agents that have been recommended under the head of hyper- 
nutrition, except that pressure is more rarely applicable; but 
it is requisite to use the remedies with more energy and de- 
cision. 

Before leaving the subject of inflammation, it is necessary to 
say a few words of engorgement', — an affection of the capillary 

powder; and his mother, by the advice of a neighbour, had filled them with 
spirits of turpentine. " The Doctor told her it ivas very good for a burn."' Bv 
the aid of five stout men, the boy was held down on the counter until his eyes 
■were well washed with a strong syringe and water! Strange to say — the "or- 
gans were uninjured! 



PHYSIOLOGICAL REMARKS. 157 

vessels often confounded with inflammation, and producing, in 
many instances, analogous results, though possessing a very 
opposite character. 

The word engorgement has been employed quite as vaguely 
as the other terms which we have had occasion to define. By 
many, it is made to include a fulness of the vessels resulting from 
a determination of blood toward an inflamed or highly irritated 
point; while others have extended its signification to the dis- 
tention observed in the vessels of a part previously weakened 
by inflammation; but these appearances are properly a por- 
tion of the train of consequences produced by capillary irrita- 
tion. 

The term engorgement should be restricted in its applica- 
tion to a condition often the very reverse of this, in which 
the distention results from causes resident, not in the part af- 
fected, but a distance therefrom. 

The causes of engorgement are purely mechanical; for in- 
stance, a tight garter is habitually worn above the knee, where 
there is but one bone in the limb, and where all the veins of 
the leg are compressed by the ligature. The circulation in 
the arteries is less embarrassed by slight forces, and the blood 
continues to flow through them into the parts beyond the gar- 
ter, with much more facility than it can return by the veins. 
The latter vessels, and finally the' capillary arteries also, are 
consequently distended, and a retarded circulation is esta- 
blished. The vessels being unable to discharge their burden, 
nature attempts their relief by calling into play the transmit- 
ting power of the tissues, and the more fluid parts of the blood 
are thrown out into the cells of the cellular tissue in the form 
of serum; the feet swell, and the patient labours under oedema 
or local dropsy. The distended vessels would be unable long 
to continue the circulation against such difficulties, unless their 
strength were increased, and nature soon endeavours to accom- 
plish this purpose by causing a hypernutrition of the coats of 
the veins which become greatly thickened, while they are at 
the same time elongated and twisted; and the patients present 
the diseased appearance called varicose veins. But altered or- 
gans can never act with as much regularity and propriety as 
healthy ones, and, after some time, the thickening of the coats 
as well as the stagnation of the blood in the veins, interferes 
with the necessary nutrition of the surrounding parts, which 
soon become incapable of carrying on their vital functions for 
want of sustenance. The absorbents continue to take up the 
particles which are thus rendered useless, while few or none 
are deposited in their place, and the weakened parts disappear, 
leaving an irregular hole or sore. Nature still struggles to re- 
store this loss; but the process of reproduction cannot be sue- 



158 PHYSIOLOGICAL REMARKS. 

cessfully carried on with injured tools and an imperfect sup- 
ply of bad materials, and the patient then labours under an 
ulcer of the leg, which it is often almost impossible to cure! 

The same results very frequently follow the simple pressure 
of the columivof blood, in persons of unusual height, who are 
obliged to be much upon their feet; and it is rare to see a man 
of fifty, measuring six feet or upwards, whose veins about the 
ankles are not in some degree varicose. The swelling of the 
feet so often observed in women during the latter months of 
pregnancy, is produced in the same way, by the pressure of 
the womb upon the veins of the pelvis; and many other sin- 
gular affections in various parts of the body result from simi- 
lar causes. If the mechanical obstruction take place in the 
heart, the patient will often suffer from general dropsy, for, in 
that case the engorgement is general. 

There is another set of engorgements of a much more se- 
vere, but often transient character. The application of cold, 
or any other direct sedative* to the whole surface of the 
body, occasioning a contraction of its capillaries, drives in- 
ward a large portion of the circulating mass; and if the veins 
of any internal organ are previously weakened, that organ be- 
comes engorged. Certain vital obstructions in the capillaries 
of the liver, are very common causes of engorgement of the 
portal circle; and if these obstructions are frequently renewed 
for a long time, all the consequences of varicosity, such as 
dropsy, thickening of vascular parts and ulceration may occur 
within the abdomen. This is witnessed in the liver and spleen 
in old cases of neglected intermittent fever. 

The proper treatment of engorgement is very obvious. 1st 
When the disease affects external parts, mechanical contri- 
vances must be made to support the veins, and all mechanical 
obstructions to a free circulation must be carefully removed. 
2d. The distention of the vessels may sometimes be relieved 
by local blood-letting frequently repeated, and by promoting 
the natural secretions of the part. If the portal circle be the 
seat of the disease, leeching the verge of the anus may be 
made to act directly in relieving the vessels of the abdomen, 
which are not provided with valves, — a course of treatment 
plainly pointed out by nature, which often effects a cure by re- 
peated attacks of piles. This remedy may be aided by saline 
purgatives, upon an obvious principle. 3d. Counter-irritants, 
of the milder and more durable cast, are often useful in divert- 

* With all due deference to the opinions of certain physiologists, we hold 
few positions to be more absurd than that which attributes the contraction of 
the circular capillary fibres to an increase of action in the part. The whole his- 
tory of disease most plainly proves that precisely as the nervous energy de- 
clines, the capillaries contract. 



PHYSIOLOGICAL REMARKS. 159 

ing the force of the general circulation from the diseased 
part. 



OF NERVOUS IRRITATION. 

The nature of the nervous influence is so little understood 
that it will not be surprising to the reader to hear that the 
characters of nervous diseases are among the most difficult of 
medical studies. Indeed but little is yet known of them. 

In the few remarks that will be made on this subject, the 
term nervous fluid will be freely employed, not because the 
nerves are vessels containing any liquid in their cavities, for 
they are solid, and have no cavities; nor because they convey 
from place to place any occult, imponderable fluid like heat, 
light, or electricity; for, though such a fluid is very probably 
secreted and conducted by the nerves, the fact remains to be 
proved. We employ the term, therefore, merely because the 
phenomena of nervous action can be more intelligibly ex- 
plained upon the hypothesis that it is dependent upon the mo- 
tions of a fluid than upon any other supposition. 

It has been stated that the power of the nerves and the ful- 
ness of the capillaries were mutually dependent on each other; 
but it must not be supposed that the influence of the nervous 
system is always lessened by the abstraction of blood, or in- 
creased by the habit of over-eating and plethora. The very 
reverse of this is often the case. As the more important vas- 
cular organs become the seat of undue determinations of blood, 
simply by over-bleeding or starvation, so the nervous centres 
become the seat of increased excitement from the general de- 
bility of the system; for it is rather the relative than the ac- 
tual strength of any part that determines its influence on the 
vital operations of the animal. 

It seems to be a law of the animal economy that there should 
be a perfect balance of power throughout the nervous system 
when in health and at rest; but that the moment we commence 
to move, or are subjected to any local excitement of the nerves, 
the nervous fluid is directed more especially to the organ used 
or irritated, leaving the remainder of the body relatively defi- 
cient in nervous energy. 

When it is recollected, in addition to the facts just noticed, 
that any cause which throws an unusual amount of blood into 
the capillaries about any particular portion of the body, has a 
tendency in the first instance to heighten the nervous power, 
it will be at once perceived that all the several classes of re- 
medies which are recommended in capillary irritation are 
equally applicable in nervous irritation ; and that the method 



160 PHYSIOLOGICAL REMARKS. 

of treatment, by counter-irritation, is peculiarly adapted to the 
management of the latter class of diseases. 

But, besides these various agents, there are others which 
appear to possess peculiar powers in increasing or allaying 
nervous excitability. Among the most important of which 
are the stimulating antispasmodics, which act as counter-irri- 
tants, and the narcotics, or opiates, which act as direct seda- 
tives on the nervous system after the excitement of the ca- 
pillaries, which they generally produce in the first instance, 
has passed away. A few words added, on the order of phe- 
nomena produced by different degrees of nervous excitement, 
and we will pass to other subjects. 

The immediate consequences of an impression made by a 
stimulant acting on a nerve, are an increased tendency of blood 
to the part, and the other preliminary steps which mark the 
commencement of an attempt at reproduction. There is also 
an acute and peculiar pain, if the nerve be a part of the sys- 
tem of sensation. The irritation commonly radiates without 
delay to both extremities of the nerve, that is, to the surface 
or organ in which it terminates, and to the nearest nervous 
centre with which it is connected. Hence arises a train of 
sympathetic affections, which have been sufficiently described 
already, and a series of functional disturbances in the organ or 
surface just mentioned, their character varying with the in- 
tensity of the irritation. It is to the last named symptoms 
that the attention of the reader is especially called at present. 

In slight cases, the functional derangement consists in a 
simple increase of activity in the natural operations of the part. 
Thus, if the nerve be a cutaneous one, the skin of the part be- 
comes redder and warmer than natural, and its sensibility is 
increased while the moisture of the part on which it termi- 
nates, instead of being checked, is rendered rather more re- 
markable. If it be an intestinal nerve, or one distributed to 
any part of the mucous membrane, an increased secretion of 
mucus takes place, or the patient is affected with symptoms 
simulating a catarrh; if it be a muscular branch, twitchings, or 
unusual motions are produced; if a nerve of the heart, palpi- 
tations ensue; if of the kidneys, the urine flows in greater 
quantity, &c. If the case be somewhat more severe, instead 
of a simple increase of the natural functions, we often observe 
those functions materially altered in character. For instance, 
in a mucous membrane the mucus is exchanged for pus; in a 
suppurating wound, the pus is replaced by a thin and highly 
irritating sanies; and in a muscle, the mere occasional twitch- 
ing is converted into a strong spasm, placing the organ entire- 
ly beyond the control of the will. The frequent repetition or 
the long continuance of this grade of irritation, sooner or later 



PHYSIOLOGICAL REMARKS. 161 

produces a change of structure in the part or organ supplied 
by the nerve. 

If the grade of the affection be very intense, the effect is re- 
versed, and the part is completely paralyzed. According to 
the organ subjected to the change, the urine ceases to flow, or 
the bladder to contract, the muscles become palsied, or the 
bowels remain obstinately bound, refusing to answer to the 
action of any purgative. And if this state continue for any 
great length of time, the patient must die, or the part will 
dwindle away for the want of use, leaving little but the cellu- 
lar tissue which originally formed it, to mark the spot which 
it previously occupied. 

Irritations of the nervous centres are the more important, 
the greater is the extent of the vital operations over which 
they preside; and when they are grave in character, the issue 
is generally mortal. 

The brain, that proud distinction of the more complex ani- 
mals which raises them so infinitely above the semi-vegetable 
existence of the simpler tribes forming the lower links of the 
animal scale, is rather a combination of centres, than a single 
centre of nervous energy; and some very curious proofs of 
this fact are presented in the history of its diseased actions. 

Portions of the brain have been lost by fractures of the skull 
in falls, and by sabre-cuts in battle — and even musket bullets 
have penetrated it without destroying life! yet, as a general 
rule, all very serious injuries of this mass of nervous matter 
are considered fatal. The danger is greater the nearer it ap- 
proaches to the junction of the spinal marrow at the base of 
the brain, for that is the spot toward which all the nerves of 
animal life, whether internal or external to the brain, appear 
to tend. 

Injuries of the upper and anterior portions of the brain ap- 
pear to be much less serious in their immediate consequences, 
than those of the posterior and lower portions, provided the 
nature of the mischief is not such as to occasion extensive ir- 
ritation, or general pressure on the brain; and this fact is beau- 
tifully consistent with the theoretical views of the phrenolo- 
gists. For the upper and anterior parts of the organ are the 
supposed seals of the moral and intellectual faculties, while 
the lower and posterior portions are the known residence of 
many of the more important instincts, and also exerts a very 
direct influence over other vital operations than those of the 
mind: and it is much easier for an animal to subsist without 
intelligence or sentiment, than he can without instinctuous de- 
sires! But all parts of the brain are too important to be long 
subjected to undue exercise, or irritation, without producing 
serious alterations in the balance of the system, and the vital 

21 



162 PHYSIOLOGICAL REMARKS. 



functions generally, and hence the reciprocity between the 
health of the body and the head has become proverbial. 

By far the most curious circumstance in connexion with the 
history of the cerebral irritations, is the possibility of treating 
them by means of mental counter-irritation — a subject which 
deserves much more attention than it has yet received from 
the profession; and one which will form, before long, the phi- 
losophical basis of the moral treatment of insanity, as it has 
already shed new light on the theory cf education! Much 
observation has convinced us that the best possible counter- 
check to the morbid excitement of the physical passions of 
man, is a close application to the study of mathematics or na- 
tural history! And, on the other hand, the over-strained powers 
of the reasoning faculties are best restored by those relaxations 
and amusements which actively employ the muscles, the senses, 
and the affections, thus exciting the nervous fibres of the pos- 
terior and lower portions of the brain. 



ON THE BALANCE OF VITAL ACTION AND REACTION. 

We have already spoken of the fact that an excitation of 
any one portion of the nervous system produces a diminution 
of the supply of nervous fluid in other parts; but there is one 
circumstance connected with this subject that requires some 
farther notice. 

Whenever an irritation is produced in any given spot, its 
vital energies are, for a time, increased, while those of the rest 
of the system are relatively diminished; but, after a certain 
time the part becomes exhausted by its unwonted exertion, 
and the scales are turned. The system becomes relatively 
more vigorous than the part affected. The same causes being 
continued in action, the part soon resumes its powers and 
again takes the ascendant under the reaction of the general 
system. In this manner a continued vibration is kept up be- 
tween the local affection and the rest of the body, becoming 
greater, or less violent, according to the comparative severity 
of the disturbing cause, and the resisting force of the consti- 
tution: This gives to the disease the appearance of periodi- 
city, so generally observed, and goes far to explain the limit- 
ed duration of fevers, their remissions and intermissions, cri- 
tical days, types, &c; matters far too abstruse to be considered 
in a popular work. 

It follows, from the remarks contained in the last paragraph, 
that the treatment required at different periods in the progress 
of any attack of disease, may be very various, and that quite 
as much depends on the proper time for the exhibition, a? 



PHYSIOLOGICAL REMARKS. 163 

upon the nature of the remedy. A bleeding that may be 
very serviceable at three o'clock in the afternoon, may be 
very improper at ten in the morning, but may be absolutely 
demanded in the evening of the succeeding day! How inju- 
rious, then, is the custom of physicians in large capitals, who 
always send for a bleeder to open a vein! In the majority of 
cases this is well enough; but the physician should never be 
without his lancet, and should employ it personally on grave 
occasions, so as to retain, at least, the facility of habit, and a 
practical knowledge of the use of the instrument. It is a cu- 
rious fact that some physicians, in extensive practice, who 
would set, or even amputate a limb, if suddenly called on duty, 
are yet afraid to open a vein! so complete is their habitual 
dependence on others! 



OF VICARIOUS DISCHARGES AND TRANSFORMATION OF 

TISSUES. 

There are some curious proofs of the influence of the nerves 
over the action of the tissues, and some that tend equally to 
establish the fundamental principle laid down in the first chap- 
ter of this work; namely, that the cellular tissue is the basis 
and original agent in the construction of all other tissues and 
organs. I allude to the cases of healthy or diseased action, in 
which one portion takes upon itself the duties and functions of 
another portion. 

If, in females, the menstrual discharge be checked, it not 
unfrequently happens that the lungs supply the deficiency by 
throwing out blood, an accident which often excites extreme 
alarm when there is little danger. In like manner, the skin has 
been known to discharge urinous matter, when the secretions 
of the kidneys have been arrested by disease. In fractures and 
wounds of all the more solid organs, when there is any dis- 
placement of the injured surfaces, nature does not content her- 
self with simply reuniting the dissevered parts, but hastens 
her operations, and renders assurance doubly sure, by calling 
on all the neighbouring tissues to supply a portion of the new 
matter, such as bone, ligament, &c, in order that the injury 
may be repaired as soon as possible. — As the object of these 
changes of function is evidently the promotion of health under 
circumstances in which it cannot be preserved by ordinary 
means, they are called vicarious discharges, or vicarious ac- 
tions: but we see similar alteration of structure frequently oc- 
curring in situations where, instead of relieving or perfecting 
the system, they oppress or injure it. Thus, all parts of the 
body — not even excepting the brain itself — have been occa- 



164 PHYSIOLOGICAL REMARKS. 

sionally seen converted into bone! and, under the influence of 
morbid causes, it seems as if the cellular tissue was furnished 
by the nervous influence, with power to create any compound 
tissue, or peculiar organic structure, not only where it should 
be, but, also, ivhere it should not be! 

When such transformation of tissue occurs, it is, in general, 
extremely difficult to discover either the cause of the change, 
or the remedy for its occurrence. When the misplaced pro- 
duct is soft, and capable of compression, pressure sometimes 
occasions its reabsorption; but when it is decidedly hard, as 
in ossifications, it is commonly impossible to effect a cure un- 
less the part affected can be removed by the knife. Even this 
last resort must frequently fail; for, if the action of the free 
cellular tissue is so seriously altered in one particular spot, 
experience teaches us that the disease is extremely prone to 
reappear in other places, after the removal of .the part at first 
affected. 

It is unnecessary to bestow further attention upon those de- 
generations of tissue which result from the absorption of the in- 
terstitial deposites of compound tissues; for these have been 
sufficiently noticed in the earlier part of this work: but the 
morbid alterations observed in disease are not confined to the 
misplacement or destruction of the various organic products 
commonly observed in the body; other, and altogether diffe- 
rent matters are occasionally deposited in the cells of the cel- 
lular tissue, having no affinity with any ordinary animal pro- 
duct Of this nature are the tuberculous matter peculiar to 
scrofula and consumption, the constituents of cancerous and 
certain fungous tumours, &c &c. Their extreme obstinacy, 
and, generally incurable character, are mainly attributable to 
our ignorance of the method in which they are produced. 

In common with all newly formed or misplaced parts, these 
diseased deposites possess less power of vital resistance than 
the original structure; and, in many cases, their presence be- 
comes a source of irritation to the surrounding parts, and ul- 
ceration of the most alarming and intractable character is a 
frequent consequence. 

Our object, in the present and preceding chapters, has been 
to give the reader some idea of the mode in which reasoning 
and scientific observations may be employed in pursuing the 
study and practice of medicine. The very hasty glance which 
has been taken, is sufficient, it is hoped, to show the fallacy of 
the popular notion that almost any one, whatever be the nature 
of his education, is capable of becoming acquainted with this 
most occult branch of human learning; and the equally un- 
founded opinion that the patient "surely knows his own con- 
stitution better than any body else/" Let any candid man 



PHYSIOLOGICAL" REMARKS. 165 

examine the complex nature of many of the problems which 
have been rapidly stated in the preceding pages, and he will 
be able to judge of the justice of the boasted powers of empy- 
rical and ignorant pretenders to skill, and how far the venders 
of universal medicines, are entitled to the confidence of the 
public. It will be well, also, if he should modestly inquire of 
himself how far he may safely venture on applying the practical 
directions, which it is the chief object of this work to place at 
his command, at times, and in situations which admit of a refe- 
rence to persons of superior information on medical topics. 

What has been stated may enable him to comprehend the 
action and the propriety of many remedial measures hereafter 
advocated; but he will find very numerous prescriptions, the 
operation and philosophy of which, he will fail to compre- 
hend, and which could not be explained to the uninitiated. 



166 REMARKS ON HYGIENE. 



CHAPTER IV. 
REMARKS ON HYGIENE. 



Hygiene, or the art of preserving health, as it is usually- 
termed, is, in reality, an important and extensive science; but 
it would be inconsistent both with the limits and the objects 
of this work, to attempt any thing more than a passing notice 
of the more valuable practical deductions drawn from its doc- 
trines and established by experience. It forms no part of our 
design to appear learned; we are only anxious to be useful. 

In fartherance of this view, the remarks contained in this 
section will be divided into five principal sections, on food, 
raiment, air, exercise, and the management of the health of 
children. Under each head will be given such practical di- 
rections as are most likely to be serviceable in the every day- 
business of life. 



OF FOOD. 

Man, is evidently constructed with a view to the mastica- 
tion both of animal and vegetable substances; and, according- 
ly, some of his teeth are constructed like the grinders of the 
graminivorous animals, while others resemble those of beasts 
of prey. 

At various eras in the annals of history, certain nations and 
sectaries, influenced by false religion, or equally spurious be- 
nevolence, have contended against the propriety of subsisting 
upon animal food. In our own day, we observe the influ- 
ence of this prejudice, nationally, in the worshippers of Brah- 
ma, and on a narrower scale, in the monomaniacal conduct of 
certain advocates of a most humane and reasonable doctrine — 
the ultra-temperance reformers! 

It is not in the structure of the teeth alone that we perceive 
the truth of the position that Providence designed both the 
beast of the field, and the herb of the garden for the support 



REMARKS ON HYGIENE. 167 

and sustenance of man! His internal organization is equally- 
constructed with direct reference to this double purpose! His 
length of small intestine involved upon itself, and the several 
enlargements and toriuous course of his great intestine, are 
evidently contrived upon the model of the herbivorous tribes, 
while his single and simple stomach, so different from those 
of the ruminating animals, is clearly designed for the less la- 
borious process of digesting meals. 

Until, then, it can be proved to demonstration, that modern 
theorists are wiser in iheir knowledge of physiology, than He 
who gave laws to the science, and constructed the master- 
piece of nature, it is ridiculous 1o argue upon the question 
which has been so much debated by a few enthusiasts! 

E/en those who act upon 1he doctrine that animal food is 
unnecessary to man, and therefore to be avoided on the prin- 
ciples of benevolence, would find but liltle encouragement 
from an actual comparison of the relative developments of 
those nations who abstain from it, and those who use it freely. 
The former are invariably weaker and less vigorous, and their 
longevity is less remarkable than the latter. 

But it is much more difficult, perhaps impossible, to deter- 
mine the relative proportion of animal and vegetable food 
which will be found most conducive to health. This propor- 
tion will be found to vary much with the climate and the 
temperature of the season. In tropical countries, the abun- 
dance of fruits and vegetables which burden the table through- 
out the year, points out, in the clearest manner, that nature 
designed the inhabitants of these regions to subsist chiefly 
upon plants; or, if we state the proposition in different terms, 
the constitution of man, in these situations, is habitually 
adapted to such food. In polar regions, on the contrary, 
scarce a trace of vegetable life remains, and the scattered po- 
pulation subsists almost exclusively upon animal food. Neither 
of these extremes is found consistent with the highest per- 
fectibility; and it is probably owing, in a great degree, to the 
proper balance between the quantity of nutriment obtained 
from the two great kingdoms of organic life, that the people 
of temperate latitudes have ruled the world from time imme- 
morial, and are likely to perpetuate their power to the end of 
time. 

Next in importance to the nature of the food taken, is the 
mode in which it is prepared for reception into the stomach. 
Man has been called, emphatically, a cooking animal, but it 
may well be questioned, whether he has gained any great ad- 
vantage by the cultivation of the culinary art. It is true that 
by the aid of fire, he appropriates to his use many substances 
which are either indigestible or poisonous in their natural 



168 REMARKS ON HYGIENE. 

state; but his bill of fare would have been very considerable, 
even if all such articles had been excluded. Be this as it may, 
hereditary habit has not only rendered cooking necessary to 
health, but even the peculiar modes of dressing employed by 
different nations and tribes have become essential to their com- 
fort; and many of the races may be distinguished by their 
food and tastes, almost as readily as by their physiognomy. 
To show how far the system adapts itself to peculiarities of 
habit in regard to food, it is sufficient to mention that a conti- 
nental European soon becomes dyspeptic when he is boarding 
at the best of English tables; and the insular traveller is liable 
to the same evil on the Continent, until long familiar with the 
luxury of a Parisian kitchen. A curious example of the same 
nature, which comes home to the bosom of an American is 
this: — It is said that it is far more disgusting to a Parisian 
belle to sit at the same table with a dish of Indian corn, than 
for the unpractised school-boy of six years, to discuss a plate 
of olives! 

If it is impossible to lay down strict rules of diet, which 
will be generally applicable to the residents of different coun- 
tries and climates, it is equally so to establish such a code for 
persons of various ages, and diverse ranks and occupations. 
The sturdy labourer in the fresh air of the harvest field, would 
starve upon the rich viands of the citizen, while the latter 
would be altogether incapable of digesting the stubborn mate- 
rial in which the latter takes delight! 

The student, whose muscular system is but slenderly exer- 
cised, and whose vital energies are chiefly concentrated in the 
brain, cannot tolerate the use of any considerable amount of 
animal food, without which, the operative would sink at his 
daily task. We have been absolutely shocked, on more than 
one occasion, when some delicate girl, whose fibres have been 
debilitated, and whose viscera have been enervated by the 
early mismanagement of nursing, and the neglect of physical 
education, has been rudely chidden in our presence, because 
she turned with loathing from the steaming of roast beef, or 
the doughy luxury of apple-dumplings! Her censor, perhaps, 
some florid, overgrown, though well-meaning tyrant of sixty, 
who has been permitted to resist the shocks of all manner of 
exposures, and, it may be, dissipations, to serve as a monu- 
ment of the prodigious power of nature in the occasional con- 
struction of invulnerable constitutions! " Have done with these 
girlish whimsies! eat it at once! It never disagrees with me, 
and I have used it these forty years!" cries the incensed and 
insensate "head of the house," and the unfortunate victim of 
"good education" retires from the table in tears, with a 
stomach additionally irritated by the want of proper suste- 
nance. 



REMARKS ON HYGIENE. 169 

There will be ample occasion, in the after part of this chap- 
ter to enlarge upon this species of domestic oppression, parti- 
cularly when speaking of boarding school mismanagement. 

The quantity of food required by an individual in health 
varies with the amount of exercise taken, and the term exer- 
cise is here employed not only to express muscular exertion, 
but must be extended much more widely, so as to include the 
operations of all the organs, both of organic and animal life. 
Digestion is itself an exercise of the stomach; perspiration, an 
exercise of the skin; thought, of the brain, &c. Now the 
more an organ is employed, so long as it is not exhausted by 
over exertion, the more rapid and considerable are its internal 
changes; or, in other words, the more vigorous is the display 
of the function of nutrition in the part; and, hence, the more 
considerable is the amount of food required. In fact, the appe- 
tite may be regarded, in one point of view, as a kind of gradu- 
ated measure by which we should always regulate the quanti- 
ty and frequency of our meals: and it is often the only test 
by which we can ascertain when exercise is promoting the 
health, and when it is injuring the constitution. So long as 
the appetite improves under gymnastic training, the nutrition 
of the body goes on with increased vigour: but the moment 
that any important part begins to suffer from exhaustion, the 
appetite declines. This circumstance will be more fully no- 
ticed in a future section. 

Of Mastication. The proper attention being given to the 
selection and preparation of food, the next thing that claims 
the attention of the student of Hygiene, is mastication. This 
process is absolutely necessary to reduce solid nutriment to a 
condition in which the stomach can act upon it with facility. 
Hence the infinite importance of the preservation of the teeth, 
the much neglected organs by means of which this reduction 
is accomplished. It is true that persons accustomed to labori- 
ous exertion, and especially those whose avocations, like those 
of the agriculturist, are pursued in the open air, may bolt their 
dinner in a few moments with comparative impunity; not so 
the delicate and sedentary! The national habit of rapid eat- 
ing, which is so universally observed in our country, un- 
less in the most refined circles of society, cannot be too se- 
verely censured. The ridicule cast upon us by foreigners on 
this account, though often intended to injure, has been of con- 
siderable advantage; and it may be confidently hoped that the 
day is not far distant when the mass of our fellow citizens will 
learn to enjoy their meals according to the custom of other ci- 
vilized people. The inquiry is very frequently made, why 
has dyspepsia become so much more general of late years than 
it formerly was? There are probably many reasons, but of 



170 REMARKS ON HYGIENE. 

these the strongest is unquestionably the habit of rapid eating. 
Perhaps it may be denied that our immediate ancestors were 
less addicted to this practice than ourselves, but supposing that 
facts may be adduced to establish this point, (which, however, 
we have not been led to believe by our researches,) the argu- 
ment would still hold good; for the habits of the greater por- 
tion of the community have been totally changed since the 
days of our grandfathers. Then, the lad of eighteen was not 
considered a man, but might be seen on holy-day afternoons 
trundling his hoop, flying his kite, or playing at fives or wicket 
on the commons like a romping boy! His father was in the 
habit of taking daily exercise in the open air; for cities were 
small, the manufacturing population did not exist, and the 
merchant did not disdain to assist in packing his own goods; 
for the division of labour was not then carried, as now, to a 
high degree of perfection; time was not so valuable, nor were 
rail-roads ever at command to convey the traveller from 
place to place in luxurious idleness, unconscious of the motion. 
In those days, even the medical student commenced the study 
of his profession by pounding continually with the heavy pes- 
tle in the enormous iron mortar to advertise the passenger that 
there resided a disciple of Esculapius! Well might our grand- 
fathers digest the half masticated dinner with less injury than 
we can! Even the habits of the weaker sex have undergone 
a similar revolution. Many a reader will remember the big 
spinning-wheel which hummed him to sleep in childhood, 
when one of the greatest recommendations to matrimony, even 
with the most fashionable of the sisterhood, was for the belle 
of the day to display on Sundays a gown of her own manufac- 
ture! Now, the progress of machinery has banished the wheel 
not only from the chamber of the metropolitan lady, but even 
from the garret of the farmer's wife! and we have been con- 
vinced by actual observation, that during this and other changes 
in domestic habits, dyspepsia has increased to an astonishing 
extent among the women of agricultural districts; and how 
could it prove otherwise when the cheese-press and the churn 
are exchanged for Scott and the piano; while apple-dumplings 
and tough pastry are demolished in double the weight and 
with thrice the velocity ! 

The injury resulting from rapid eating is not confined to the 
mere result of imperfect mastication; for it is well known that 
the cravings of hunger are satisfied by a much smaller quanti- 
ty of food, when sufficient time is allowed to each meal, than 
when the business of the table is hurried through in a few mi- 
nutes; and this fact, in connexion with the prevalence of the 
vulgar custom on which we have been animadverting, goes far 
to explain the frequency of plethora, headaches, habitual cos- 



REMARKS ON HYGIENE. 171 

tiveness, and chronic hepatic disease in females and studious 
men. Some may be surprised to hear costiveness attributed 
to over eating; and indeed this affection, in the cases referred 
to, appears to depend quite as much on the want of exercise, 
as upon the errors of the table; for moderate agitation pro- 
motes the evacuations and the activity of all the actions of or- 
ganic life, although severe jolting, such as we experience in a 
stage-coach on a rough road, diminishes their activity: — yet, 
excess in eating, by destroying the tone of the stomach, by 
calling upon it for unusual exertions, prolongs the stay of the 
food in that organ, and prevents it, at the same time, from un- 
dergoing the changes which fit it for passing through the ali- 
mentary canal with promptitude, and thus it becomes, not only 
an additional cause of costiveness, but a fertile source of intes- 
tinal and sympathetic irritations. 

There is a mutual relationship between the condition of the 
stomach and the teeth, which is so intimate that if either be 
seriously affected the other is sure to suffer — and thus the ha- 
bit of rapid eating has a tendency to destroy the teeth, and 
is one of the principal causes of the proverbial prevalence of 
decay in the teeth on this side of the Atlantic. 

Use of Saliva in Mastication, It is not only by occasion- 
ing a mechanical division, and a crushing of solid aliments that 
mastication promotes the process of digestion; for it also se- 
cures the complete admixture of the food with the saliva, — a 
fluid which undoubtedly serves a double purpose in aiding na- 
ture in this most important operation. Though it is extreme- 
ly probable that a peculiar liquid secreted by the stomach it- 
self, is chiefly concerned in dissolving the food and convert- 
ing it into chyme, yet there is every reason to believe that 
the saliva also contributes essentially to the solution. At all 
events, any disease which diminishes or vitiates the secretion 
of saliva, invariably produces a very serious disturbance of di- 
gestion, and every habit which occasions a useless expendi- 
ture of spittle gives rise to the same kind of mischief. Dis- 
eases of the pancreas, which organ, as has been already stated 
in the physiological chapter, is a kind of internal salivary 
gland, are frequently attended by results in many respects si- 
milar, but not perfectly identical. The reason of this is easily 
explained. The pancreas pours its secretion into the duode- 
num or commencement of the small intestine, and the food 
must pass from the stomach, which is the first and most im- 
portant digestive organ, before it can be submitted to the ac- 
tion of the pancreatic liquor. This fluid, therefore, cannot 
properly supply the place of the saliva; for, in the absence of 
the latter, the mischief is done before the remedy is applied. 
Irritations of the pancreas react primarily on the small intes- 



172 REMARKS ON HYGIENE. 

tines, while those of the salivary glands react upon the sto- 
mach. 

-Though the intestinal canal is lubricated plentifully by its 
own mucus, under all ordinary circumstances, it requires some 
assistance in giving a free passage to solid aliments, which 
would inevitably carry away the mucus, and come into con- 
tact with the delicate surface beneath, if these substances were 
not previously coated and intermingled with some other ad- 
hesive and diffusible fluid, calculated to prevent friction. This 
fluid is found in the saliva, which lubricates the whole surface 
of the passing mass, and prevents all irritations of the surfaces 
beneath. To the action of this fluid the reptiles owe the power 
which they possess, of swallowing with facility substances of 
greater diameter than that of their own body, as we frequent- 
ly observe in the snakes. 

The use of tobacco and its injurious effect on the constitu- 
tion may be mainly explained upon the principles which have 
now been laid down. This drug is a native of our climate, 
and it is natural that it should be held in more general appro- 
bation amongst us than in most foreign countries; and hence 
it becomes the more important that we should point out the 
evils which follow its employment. 

In all its various forms, tobacco acts as a narcotic, and les- 
sens the nervous activity of the individual, especially in the 
parts to which it is directly applied; but, like all other articles 
of the same class, except, perhaps, prussic acid, and one or 
two others, it stimulates before it lulls. In the stimulating 
stage of its action, the sensations which are produced by it in 
persons who use it habitually, are highly pleasurable, and the 
secretions of the surface and surrounding glands are for a time 
increased. Even the exhaustion which succeeds this hyper- 
excitement is often agreeable, especially to persons of warm 
temper; but there is always an ulterior period of lassitude and 
depression, like that which follows the use of alcoholic stimu- 
li, and requiring a repetition of the dose for its relief. Unfor- 
tunately, tobacco is a poison to which the human system adapts 
itself with astonishing facility — though so horrible in its ef- 
fects when employed in any considerable quantity at first! 
But let none deceive himself into the belief that this adapta- 
tion is perfect, and that he can employ his favourite weed 
with impunity or benefitT The mischiefs resulting from in- 
dulgence, though latent, are not the less certain. The use of 
tobacco by snuffing is, perhaps, the most exhilarating and 
harmless mode of employing it; but even in that form it soon 
renders the mucous surfaces of the nose and throat drv and 
harsh, and places them in a condition which increases their 
liability to ulceration, while it destroys the delicacv of the 



REMARKS ON HYGIENE. 173 

sense of smell, and changes the tone and quality of the voice 
in a manner destructive of all eloquence! 

There are occasions on which snuff, hy provoking spasmo- 
dic sneezing, may prove serviceable in disease: there are 
others in which there would be great danger of determining 
an apoplexy from the same cause. In persons who are unused 
to snuff, it may produce some benefit in chronic inflammation 
of the eye, and in temporary deafness from catarrh; for the 
effects of most substances applied to the mucous surface of the 
nose, are extended to the eye and ear, — the external mem- 
brane of the former, and the internal lining of the latter or- 
gan, being formed by extensions of the nasal mucous mem- 
brane. For the same reason, it is probable that the long-con- 
tinued habit of snuffing, may occasion an imperfection of hear- 
ing, and an enlargement of the blood vessels of the eye; ef- 
fects which we think we have frequently witnessed in snuff 
takers who have passed middle life. 

The extent of mucous surface, impressed by the use of snuff, 
is less considerable than that which is acted on by smoking or 
chewing tobacco, and it is less closely associated by sympathy 
with the stomach, while it stands in even closer relation with 
the brain. Stimulating powders are therefore employed in 
many cases to relieve obstinate headaches, and although they 
can scarcely be classed among the very active remedies, their 
effects have sometimes proved advantageous. Snuff may be 
occasionally serviceable upon a like principle, but it acts most 
powerfully in a manner the reverse of the stimulating powders, 
though producing, in the end, the same result. The latter act 
as counter-irritants, calling off the nervous power from the 
brain to the olfactory nerves; the former diminishes the sensi- 
bility of the olfactories, and this sedative impression is extend- 
ed to the brain. But it appears that most substances taken 
into the nose or mouth produce their characteristic effects most 
decidedly on the fifth pair of nerves, which are intimately 
connected with, and necessary to the perfection of all the 
senses alike; so that if any minute branch of these nerves be 
injured, it is quite possible for the taste, smell, hearing, or 
sight to be seriously affected by the accident. Disorders of 
this kind are occasionally witnessed after the extraction of 
teeth; and the dentist is sometimes censured harshly for an 
unavoidable result, — fortunately, the evil is almost never per- 
manent. It is chiefly by virtue of this action on the fifth pair 
of nerves that tobacco sometimes proves serviceable in tic do- 
loureux, neuralgia of the head, tooth, and earache, &c, when 
these complaints are chronic, or of long continuance; but it 
does not follow that the occasional success attending the use 
of this poison, will justify us in considering it the best article 



174 REMARKS ON HYGIENE. 

in the treatment of such cases:— still less defensible is the po- 
sition that the habit of using tobacco is proper with a view of 
preventing a tendency to such attacks — for it would be just 
as reasonable to advocate the chewing of opium, because that 
drug relieves pain in certain cases of local injury to which all 
men are liable! It is plain, then, that tobacco, like all other 
poisons, is occasionally valuable as a medicine, but that, by 
employing it habitually, except under very peculiar circum- 
stances, we injure our constitutions and deprive ourselves of 
the advantage of the present effect of the remedy when it is 
imperiously demanded. 

Smoking and chewing both act much more powerfully on 
the digestive functions, than taking snuff; but there are consi- 
derable differences in their mode of action. In smoking, tobac- 
co acts upon a much wider surface, though in a milder man- 
ner. It is impossible to avoid the frequent inhalation of the 
fumes of the common cigar into the lungs; those of the pipe 
are still more liable to enter the air passages; and the hookah* 
is expressly intended for inhalation. The latter instrument 
displays, in the strongest light, the extreme susceptibility of 
the lungs to the action of vapours thus introduced, and the ra- 
pidity with which the whole system may be acted on through 
this route. The Hindoos commingle spices with their tobacco, 
and dilute it with conserves, and then inhale until the lungs 
are completely filled with smoke. Novices in the use of 
the hookah are often intoxicated in a few minutes by the prac- 
tice. From this it follows that the influence of smoking is dif- 
fused more generally over the whole system, and that the sto- 
mach suffers indirectly. Smoking, by its action on the lungs, 
occasions obstinate thirst, and general debility. The former 
result leads to the employment of immoderate draughts of 
fluid, and the latter incites us to the use of stimulating food 
and drink: thus, dyspepsia and intemperance are the ordinary 
consequences of habitual smoking. Chewing, on the contrary, 
produces a more intense effect upon a smaller surface. Its ac- 
tion on the kindred senses of taste and smell is very powerful, 
and the stomach immediately sympathizes with the mouth. 
The flow of saliva is also rendered unhealthy, and increased 
in quantity. If ejected from the mouth, ihe digestion suffers 
from the absence of the fluid in dissolving the food, — an evil 
which cannot be prevented by substituting water, or stimu- 
lating liquors: it it be swallowed, it enters the, stomach com- 
bined with a virulent poison, which, however its effects mav 
be diminished by habit, can never be rendered innoxious. To 
prove how terribly deleterious is this article so common! v 

• The East Indian pipe. 



REMARKS ON HYGIENE. 175 

employed by our fellow-citizens, it is only necessary to men- 
tion the fact that death by vomiting has been known to follow 
the application of two leaves of moistened tobacco to the wrists 
of a delicate patient! We sometimes employ injections of to- 
bacco to produce general relaxation in certain surgical acci- 
dents, but the remedy is so dangerous that it is recommended 
with extreme caution, and its prescription by any other than 
experienced men should be discountenanced by every one 
who has a proper respect for human life; yet it is not unusu- 
ally administered by quacks and ignorant nurses, even in chil- 
dren! 

The quantity of food taken into the stomach is a matter 
scarcely less important than its quality. When excess is car- 
ried to a very great extent, the mere mechanical effect of dis- 
tention on the circulation is sufficient to produce serious effects 
in many cases. The abdomen being called upon to give en- 
trance to a much larger amount of contents than it is in the 
habit of accommodating, the abdominal muscles cannot relax 
sufficiently to give it room, and the enlargement of the sto- 
mach on the one hand, with the resistance of the muscles on 
the other, press the blood mechanically out of the vessels of 
the intestines and the portal system. Consequently, the other 
blood vessels and the heart arc oppressed and overloaded, — 
the skin becomes florid or purple, — the pulse laborious and 
slow, — the ideas confused, and the whole system is rendered 
uncomfortable and inactive, until the food has been in part di- 
gested and absorbed, and the muscles of the abdomen gradu- 
ally dilated. This state of things is highly dangerous, and ac- 
counts for the frequent occurrence of apoplexy immediately 
after a hearty dinner or supper. 

The continued habit of over-eating in this manner, produces 
a gradually increasing permanent distention of the stomach, 
and destroys the tone of its fibres, so that in time they cannot 
produce sufficient pressure upon the contents to promote di- 
gestion, and it is only when the stomach is well filled that this 
process can be carried on with activity — consequently, a por- 
tion of food remains too long in the cavity after every meal, 
and becomes a source of irritation and dyspeptic symptoms. 

If the distention from over-eating is produced rapidly, it 
generally excites nausea, and the offending matter is often 
thrown up by vomiting, by the same process which we ob- 
serve in the evacuation of all the other hollow organs. 

The remarks just given explain the ill effects of the me- 
chanical embarrassment of the stomach, but it is also liable to 
debility or disease from an undue exercise of its physiological 
functions. When highly spiced, or strongly stimulating arti- 
cles are employed in considerable amount, the powers of the 



176 REMARKS ON HYGIENE. 

organ are taxed to the uttermost, in order to effect the process 
of digestion with the greatest rapidity. This higher excite- 
ment is followed by an equivalent loss of energy which does 
not pass off until the stomach again requires the exercise of 
the digestive function, when it is called into unusual exertion 
with exhausted powers; and, consequently, it performs its of- 
fice imperfectly, and soon becomes incapable of maintaining 
the proper equilibrium with other parts of the system, which 
is necessary to the preservation of health. Though the debi- 
lity occasioned by the last mentioned cause does not affect the 
muscular coat of the stomach in the same manner with mecha- 
nical distending forces, it is nevertheless a most fruitful source 
of dyspepsia. 

It is laid down as a law by many, that we should always 
leave the table with an appetite, if we desire to promote our 
health: but this is by no means necessary, for it is quite suffi- 
cient that we should avoid decided over-distention, and all un- 
due stimulation of the stomach. 

As a general rule, children require vastly more food in pro- 
portion to their size than adults, and the requisite quantity 
•continues to decrease with advancing age, and for the best of 
reasons: — the vital operations, and the rapidity of the changes 
^effected by nutrition, become much less marked as we grow 
older, and the waste of the system being thus rendered less 
considerable, a smaller quantity of food is required to resup- 
ply it. 

The reverse of this appears to be the case with regard to 
the stimulating qualities of the food. The advance of age is 
attended by a loss of excitability in all the nerves chiefly from 
habitual excitement, and a consequent decline in the vigour 
of the organic functions. The vital powers are then frequent- 
ly invigorated by the moderate use of diffusible stimuli, and 
highly seasoned food — so that some of the very causes of dys- 
pepsia in early life may be classed among its preventives at a 
later period. 

Of drink, little need be added after the remarks on solid 
food, which have been already offered. The same principles 
with regard to distention and stimulation, hold good in refe- 
rence to fluids, but it may be well to impress upon the reader 
a fact which has received too little attention from medi- 
cal men and teachers of Hygiene; namely, that the drinking 
of immoderate quantities, even of pure water, is among the 
frequent causes of debility of stomach and disturbed digestion, 
thus paving the way for ill health or serious disease. In a na- 
tural condition of the organ, all reasonable quantities of fluid 
are very speedily taken up by the absorbents, carried into the 
circulation, and, if not required, thrown out by the kidneys 



REMARKS ON HYGIENE. 177 

and by perspiration: but when the quantity taken is sufficient 
to produce a full distention of the stomach, its fibres become 
habitually relaxed, and the fluid will then lay for hours in the 
cavity, and its presence there may be recognised by its regur- 
gitation whenever the body is much agitated by running, leap^ 
ing, riding, or any sudden motion. The way for the encroach- 
ment of disease in after life, is often laid in early childhood, 
by the habit of drinking too much water at a time, and it is 
well for all persons having the slightest tendency to dyspepsia 
to guard against this habit. When the weather, or any other 
cause provokes excessive perspiration, or when the quantity 
of urine discharged is very great, more water is required to 
supply the drain; but it should be taken, not in large draughts, 
but In small quantities, frequently repeated. It is, however, 
much better to employ such measures as are calculated to di- 
minish the drain, rather than to increase the supply. 

We shall enlarge upon this subject in speaking of the effects 
of stimulating drinks. 

The use of Stimulating Drinks has given rise to so much 
discussion of late years, that it would be wrong to treat the 
subject with neglect in a work like the present. The incalcu- 
lable evils following the abuse of such articles have produced 
a popular action and a state of public feeling on this subject, 
which, like most excitements, have outstripped the bounds of 
reason, and while effecting vast alleviation of the misery flow- 
ing from intemperance, have occasioned a reaction unfavoura- 
ble to the calm discussion of the question. Not contented with 
the condemnation of the alcoholic liquors, the free blood of 
the generous vine, and the fermented juices of the fruits and 
grains, some advocates of temperance have carried the war 
much farther and reprobated the use of tea and coffee, mustard, 
pepper, and vinegar! These are all stimulants, they allege; 
and total abstinence from stimulants is the only protection 
against the insidious approach of habits of intemperance! We 
have here ample proof of the ridiculous extent to which theo- 
rists may be carried who neglect to define their terms, and also 
of the necessity for the diffusion of a little more physiological 
knowledge among the mass of the community! The student 
of the philosophy of life well knows that nearly all articles 
which sustain the human body and support animal life are sti- 
mulants, and those who have noticed what has been stated 
in the preceding chapter, under the head of counter-irritants, 
must have perceived that the application of a stimulant to one 
part of the body is often among the most certain means of di- 
minishing the energy of some other part. A partial or one- 
sided view of these facts formed, indeed, the foundation of one 
of the most lauded medical theories of former times, whicji 

23 



178 REMARKS ON HYGIENE. 

taught that " life is a forced state," and that the action of sti- 
mulants not only supported, but actually constituted life! It 
is -certain that without the use of stimulants life cannot be sus- 
tained, and the only remaining question is, what particular sti- 
mulants are healthful, and what are dangerous. 

Alcohol in its pure state is a rapid poison, which acts pow- 
erfully on the tissues with which it comes in contact. Taken into- 
the stomaeh> it probably alters the texture of the mucous coat, 
and whether it can then be absorbed into the circulation has 
not been ascertained. All that is known is that it will occa- 
sion death. 

Alcohol diluted is a slow poison, and like most other arti- 
cles of the same class, may occasionally prove useful in main- 
taining health or curing disease;, but an habitual resort to any 
of the liquors containing this article, whether the quantity taker* 
be large or small, invariably injures the health, though from 
the slowness of the approach of its ill consequences, they fre- 
quently escape notice, and when perceived, are often attributed 
to other causes. Diluted alcohol does not change the charac- 
ter of the surfaces on which it is applied, as the pure spirit 
does; and it is therefore freely absorbed, and enters the circu- 
lation, extending its influence to every blood vessel in the 
body. Of course, as this fluid contains no nourishment, and 
is altogether foreign to the blood, it is speedily thrown off from 
the system with some of the secretions; but it is a curious cir- 
cumstance that very slight differences in the purity of alcoho- 
lic liquors occasion an unaccountable diversity in their effects, 
Thus, alcohol diluted with pure water, brandy, gin, whisky, 
&c. y though alike in all respects except in the presence or ab- 
sence of a little vegetable matter, — which is sometimes sa 
small in amount as to be scarcely appreciable by weight, — pro- 
duce impressions on the system of widely dissimilar character. 
For instance: — the alcohol, simply diluted, generally acts as a 
purgative, and is probably absorbed with difficulty, as its ef- 
fects on the brain are confined pretty much to a pleasurable 
sensation, evidently resulting from a simply nervous or sym- 
pathetic impression, like the first enlivening effect of Cham- 
pagne. This peculiarity has induced us to employ half an 
ounce of the pure alcohol diluted with a gill of water, as a 
mild laxative in certain cases of extreme debility, and although 
we would be far from warranting its use by persons not of the 
profession, yet it might be proper to call the attention of me- 
dical men to the subject, as the spirit in this simple state has 
never been employed in general practice. Gin, on the contra- 
ry, which can scarcely be distinguished from simple diluted 
alcohol, except by the presence of a mere trace of a volatile ve- 
getable oil, is taken into the circulation with more rapidity 
than any other liquor, and is cast out with equal speed: but 



REMARKS ON HYGIENE. 179 

it does not act as a purgative, except in a few rare instances, 
its chief operation being on the kidneys, which it siimulates 
to an increased flow of urine. The intoxication resulting; from 
gin, is therefore prompt, but evanescent. 

The diuretic properties of gin give this liquor a preference 
over all other spirituous liquors in certain cases of dropsical 
effusion. 

Whisky, which can scarcely be distinguished from gin by 
its chemical properties, differs from it in producing a more 
permanent effect, and in provoking more free perspiration. It 
also acts strongly on the kidneys. When taken hot and mixed 
with molasses ajid some other articles, as is often done by di- 
rection of elderly ladies who are fond of domestic medical 
practice, its diaphoretic powers may sometimes prove highly 
serviceable at particular moments in the progress of catarrh, 
and even in some cases of intermittent fever, before the coming 
on of the chill; but it is a dangerous remedy, and under popu- 
lar guidance, probably destroys more than it relieves! 

Brandy, as it is commonly employed, is coloured with a 
considerable amount of vegetable matter, and it is probably 
owing to this circumstance that it acts so differently, in some 
respects, from the liquors already enumerated. It has a ten- 
dency in most persons, and under most circumstances, rather 
to check than to promote perspiration, and sometimes even re- 
strains the secretion of urine! As it readily enters the circu- 
lation, and is thrown off from it with difficulty, its effects are 
much more permanent than those of other liquors, particularly 
•on the nervous system; and for this reason it is one of the 
most unwholesome products of the still for the inhabitants of 
cold or temperate climates, and in dry situations: but, like 
most other noxious agents, it has its useful applications: — it is 
the best of the diffusible stimulants, where such stimulants are 
positively demanded among the old residents in swampy dis- 
tricts within the tropics. Fortunately, the regular alternation 
of the seasons in other regions prevents that constant exhaus- 
tion from perspiration and the undue rapidity of all the vital 
actions which characterize life in equatorial countries; and our 
remarks upon the use of brandy cannot, therefore, be quoted 
in defence of its abuse. If brandy, or any other alcoholic li- 
quor be freely employed by the unacclimated in climates like 
that of Bengal, Batavia, &c, the danger of almost immediate 
death is rendered extremely great, so much so that it has been 
said that more than one half of all the foreigners settling in 
Calcutta and its vicinity die before the expiration of the first 
year, and chiefly in consequence of indiscretion in employing 
stimulant drinks which the custom of the country continual- 
ly places before them! Yet how ridiculous is the attempt to 



180 REMARKS ON HYGIENE. 

reason on this subject, like a quack upon his panacea, and to 
force all mankind to follow an intemperate temperate faith, 
until they become capable of living on bread and water! If 
the old residents in India were deprived of their brandy or 
other stimulus, the mortality among them would probably be 
raised to the same standard; 

It will be questioned, very naturally, by the advocates of 
temperance, how the remarks just mentioned can be rendered 
consistent with the position previously taken, that the habitu- 
al use of such liquors proved invariably injurious? the answer 
is a simple, though a curious one. The climates in which al- 
cohol becomes almost indispensable to life, are precisely those 
in which it is impossible to preserve the health for a long time 
by any measures. In Bengal, for instance, so universal is the 
prevalence of chronic liver complaint, that the lowest mercan- 
tile officer of the British East India Company is permitted to 
be absent from the country without the loss of salary, at least 
six months in every period of five years, in order to recover 
some little energy to resist the ceaseless sapping of the heat 
and miasmatic vapours of that interminable swamp! Yet even 
with every precaution, it is almost impossible to avoid hepatic 
disease for five years consecutively. The late celebrated mis- 
sionary chief, the Rev. M. Carey, was said to be the only man 
of the pure European race who ever continued in good health 
for ten years in Bengal! The cause of this wide-spreading 
affliction is beautifully laid down by Johnson in his work on 
tropical climates. The long-continued heats, unrelieved by 
frost at any season of the year, produce a constant Interac- 
tion on the skin. The perspiration is poured out almost un- 
ceasingly, and in immoderate quantities; the skin becomes 
debilitated, while it still continues under the action of power- 
ful exciting causes, and the liver suffers sympathetically; for 
it is found that all general impressions upon the skin, have 
also a strong action on the liver. Extreme general exhaustion 
and debility are the natural consequences of the immoderate 
flow of perspiration; and the European residents of such coun- 
tries as Bengal are thereby enervated to such a degree that 
they become incapable of sudden or powerful exertion: — their 
very voices are generally low and whispering, and their enun- 
ciation so slow that they are often understood with difficultv! 
Such debility is exceedingly dangerous, as it renders the >vs- 
tem peculiarly liable to disease from trivial causes. Diffusible 
stimuli are so necessary to elevate the exhausted powers, that 
even the curries, and the hot spices which Providence has 
planted in those countries, — certainly not without design. — 
prove insufficient to arouse and support the vital energies With- 
out the aid of alcoholic liquors, and of these, the Im 



REMARKS ON HYGIENE. 181 

brandy, because it acts more favourably on tbe skin, and rather 
tends to diminish than to increase the perspiration. Yet let 
it be remembered that the necessity for the employment of 
such a poison grows out of the previous habits and hereditary 
peculiarities of those who are foreign to the countr} T : — the in- 
digenous races of men require no such support, and are really 
the more healthy for that precept of their religion which pro- 
hibits the employment of strong drink! 

The propriety of using stimulus after long residence in hot 
and damp countries, is proved by the fact that even ladies in 
India will often take a daily allowance of brandy and water 
sufficient to intoxicate a resident in temperate climates, yet so 
far is the custom from establishing a love of drink, that the 
moment a resident leaves the country and breathes the fiee, 
mild air of the ocean, he ceases to call for his brandy, often 
without being aware that he has changed his habits! The ne- 
cessity exists no longer, and the desire ceases; so that if he 
become intemperate, it is only after another apprenticeship to 
the bowl ! 

It is easy, by a little reflection on the remarks just made> 
to trace the few cases in which the use of spirituous drinks may 
become proper in persons in health not resident in hot and 
damp situations. 

When those who have passed middle life, find themselves 
extremely debilitated in consequence of the gradual decline of 
the vital powers so constantly observed as we advance in age, 
rendered more remarkable, perhaps, by previous habits of dis- 
sipation or precocious luxury, it may be advisable to resort 
occasionally to some diffusible stimulus calculated to give tem- 
porary energy to the functions of life, if an undue determina- 
tion of excitement to any particular organ threatens the de- 
struction of the balance of health* When great exposures to 
cold, or the depressing effects of miasmatic vapours, or impure 
air, have brought on extreme weakness or chilliness, a little 
gin or whisky may prove highly serviceable in hastening 
the reaction and increasing the excitement of the surface; but 
it must be remembered, that it is only after the exposure that 
the rule applies, for no point in Hygiene is better established 
than the fact that the use of stimulants before or during the 
exposure to cold, tends to lessen the power of vital resistance. 
Nor should it be forgotten that the remedy is here employed 
medicinally , and not as an article of diet. 

In our own country, or rather in the northern part of it, the 
heats of summer are not continued for a sufficient length of 
time to induce the necessity of employing the same regimen 
which is required between the tropics, and it is found by con- 
stant and ample experience, that even the labourers in the bar- 



182 REMARKS ON HYGIENE. 

vest field accomplish a greater amount of labour, and endure 
with impunity much longer exposure to the intense heat of 
the sun when denied the use of alcoholic liquors, than when 
indulged in them ; and the only occasion on which they are 
available in assisting labour, is when an individual is called 
upon by dire necessity to perform services for a short time 
only, but which exceed his natural ability. For such a pur- 
pose, when the task is to be accomplished in a very short time, 
the distilled liquors are perhaps the best stimuli ; but when 
the exertion is to be continued for some hours, the malt li- 
quors are decidedly preferable. Unfortunate necessity alone, 
can furnish an apology for such trials, and although by the aid 
of the stimulation, the work may be completed without any 
seeming difficulty, the individual invariably suffers, subsequent- 
ly, all the evils of a state of exhaustion proportionate to the de- 
gree of over-exertion, and the effect of the beverage. Repeat- 
ed attempts of this nature prove inevitably ruinous to the 
health. 

We have now attempted to point out the few cases in which 
alcoholic liquors may be considered admissible as articles of 
regimen. It is unnecessary to dwell particularly on the man- 
ner in which they gradually undermine the health when ha- 
bitually employed, that matter having been explained in our 
remarks on the action of highly seasoned solid food; but it 
may be well to mention that the liver is seriously affected in 
almost every case of even the moderate, but habitual use of 
spirits. It is also remarkable that the brain often becomes 
hardened in consistence, and performs its office much more 
sluggishly under the operation of the same causes. It is by 
no means necessary that the habit should be carried even to 
occasional inebriation, in order that these changes should 
take place; they are not uncommonly met with in persons 
who have always enjoyed the character of temperate men. 

As it forms no part of our intention in the present essay to 
produce a connected treatise on Hygiene, we shall here close 
our remarks on drink, without taking especial notice of the 
various fermented liquors; for the knowledge of their various 
qualities, and the numerous poisonous substanees and hetero- 
geneous mixtures with which they are adulterated, or by which 
they are imitated, is now industriously circulated by those dis- 
ciples of temperance whose peculiar notions on some subjects 
we have been compelled to combat, but whose labours have 
been of incalculable value to the public, as none are more hap- 
py to acknowledge than ourselves, for none have had more 
ample testimony of the fact. The subject of mineral waters 
is also avoided, because that portion of society who are able 
to resort to the springs, very readily and cheaply obtain in 



REMARKS ON HYGIENE. 1S3 

other popular treatises, much fuller information as to their na- 
ture and uses than could possibly be compressed within the 
space allotted to the Hygienic portion of this work. 



OF CLOTHING AND CLEANLINESS. 

The subjects of clothing and cleanliness are so intimately 
connected in some respects in their relation to Hygiene, that 
it is deemed better to include them both in the same section, 
than to devote a distinct section to the remarks on baths, as is 
usually done in works of a similar character. 

It is obvious that man requires, in most countries, the aid of 
artificial covering to protect him against the vicissitudes of the 
weather; and although, in some tropical districts, this protec- 
tion is nearly or entirely neglected by the natives, yet the 
delicate skin of the white race requires to be secured from the 
scorching heat of the sun at the equator, no less than to be 
sheltered from the cold in other and more rigorous latitudes. 
Many generations would probably pass away, before the action 
of that wonderful law of the animal economy which adapts the 
constitution of man to almost all varieties of circumstances 
could bring about those changes which would permit the Euro- 
pean to endure the exposures known to be harmless to the 
African. Many nations, it is true, expose particular portions 
of the person which others religiously cover, and hence arise 
a variety of opinions, both as to the propriety and expediency 
of particular costumes. " The more you expose a child to the 
air, and the lighter the dress he wears, the more vigorous and 
hardy you make him," says some theorist in education. " Let 
him run about without shoes or stockings, and dabble in the 
wet as much as he pleases — the dirtier the better! Children 
thrive in the dirt!" The rough sons of certain agricultural 
districts, where this advice is followed to the letter, even for a 
longer period than during the age of childhood, seems indeed to 
furnish abundant evidence in its favour; but if we inquire more 
particularly into the history of families in these sections of 
country, we shall be startled at. the sacrifice of human life 
which has been incurred in effecting this physical induration. 
We shall find that nearly all the feeble and delicate are killed 
off by the experiment within the first two or three years; 
leaving none but those on whom nature has bestowed the har- 
diest constitutions to be subjected to the discipline above re- 
commended! It is true, indeed, that a Scottish Highlander in 
his kilts, will undergo with impunity exposures which would 
probably prove fatal to almost any of his neighbours of the 
lowlands, but it must be recollected that hereditary habit re- 



184 REMARKS ON HYGIENE. 

organizes human nature, and there has been little in the social 
position of the Highlander to do away with the physical pe- 
culiarities which he derives from his savage ancestors, among 
wnom exposure continued a necessity until the laws of life 
rendered it innoxious. 

Another sect would teach us that it is wisest to be armed at 
all points against the variations of the seasons; that every por- 
tion of the body which admits of it should be well and warm- 
ly clad, until we are compelled to live in an artificial hot cli- 
mate of our own creation! but it would be well to remind 
these advocates of excessive caution, that the Romans constant- 
ly exposed the neck, and we are not informed that these hardy 
conquerors of the world were particularly subject to anginose 
affections. In our own day, the fashionable belle provides us 
with a far more important illustration. Her half clad feet and 
chest, her bare neck and shoulders, are alternately subjected 
to the heat of the ball-room, and the chill air of the theatre; 
and her dress — in its very structure illy-fitted to protect the 
person — is invariably composed of the thinnest materials which 
can be tolerated, in order that comfort, safety, and principle 
may be immolated on the altar of taste! It is true that these fol- 
lies are not indulged with impunity, as the weekly bills of 
mortality amply testify, but that they are not universally fatal 
to the feeble frames and enervated constitutions of these hyper- 
refined creations of artificial society is quite sufficient to prove 
that the system of extreme caution in dress advocated and prac- 
tised by many, is not by any means essential to health: nay, 
it is even injurious, for constant protection against vicissitudes 
of temperature, climate, and accidents is altogether impossible; 
and the fact that undue warmth strongly predisposes the indivi- 
dual to taking cold from trivial causes, is established beyond 
dispute by the observation of those who reside in tropical 
countries. In Bengal, during the month preceding the rainy 
season, when the thermometer ranges constantly and very gra- 
dually between 85 and 105 degrees of Fahrenheit, it is exceed- 
ingly common for severe catarrhs to result merely from the 
waving of the hot air by the punkah, or large fan, which forms 
part of the furniture of every saloon! If, then, we accustom 
any part of our persons to an undue degree of warmth or co- 
vering,* we lay ourselves open to additional danger from tri- 
vial accidents. 

* It is a common error to suppose that the presence or absence of even the 
slighter tissues, is a matter of indifference in dress. Let a lady remove her 
gauze veil, or a gentleman shave his favourites, when about to face a keen 
north-wester, and the result will fully convince the party that neither gauze 
nor hair can be despised with impunity. Slight irregularities in the clothing 
of the feet are often the causes of much more serious disasters, than those of 



REMARKS ON HYGIENE. 1S5 

In order to ascertain what medium in dress is just and pro- 
per in particular places and for particular persons, it is neces- 
sary to consider what parts of the body most require protec- 
tion in all persons; and what peculiarities of the sexes require 
corresponding cautions with regard to other parts. The first 
of these questions alone requires attention here. 

1st. What parts of the body most require protection in 
all persons? The same general laws which have been noticed 
in the preceding chapters are equally applicable in this depart- 
ment of Hygiene. As those organs of animals which appear 
first in ascending the animal scale are always the most impor- 
tant, because they are those most essential to the growth and 
existence of the animal, so they require the most perfect pro- 
tection; for a disorder in their operations must necessarily dis- 
turb the whole system more certainly and seriously than a 
similar irregularity in any other parts. The abdomen is 
formed long before any other cavity, and within its walls is 
concentrated nearly all the apparatus of vegetative or organic 
life, (see p. 186.) Here, then, is the part which requires the 
most careful protection, for here is found the fundamental or- 
ganization on which the building and repair of the whole body 
depend! But this protection is more necessary in early life 
and in advanced age, than during the intervening period, for 
the following reasons, 

Ineaily life, all the vegetative or merely organic operations 
of the animal are carried on with energy and rapidity, because 
the building is then about being constructed, while in middle 
life, the process of assimilation is only required for repairs. 
Those portions of the apparatus which arc most constantly 
employed, are of course most liable to get out of order, and 
should therefore receive the most careful attention. On the 
contrary, in old age, the same parts become sluggish, and the 
demands made upon them are comparatively few; but at the 
same time, their internal organization Ls rendered imperfect 
by the deposition of an unusual number of particles within 
their substance, producing that species of induration of which 
we have spoken in a former chapter, as one of the characteris- 
tics of age in all parts of the body. It follows from these 
facts that, although the abdominal organs become less suscep- 
tible of impressions in advanced life, their powers of vital re- 
sistance are also diminished; and it is found by actual obser- 
vation, that more is lost in point of safety, by the latter, than 
is gained by the former alteration. 

more apparent consequence; for nature, like man, though prepared for great 
occasions, often seems negligent of trifles! and it is safer to run barefooted in 
the snow, than to change boots for shoes during cold or damp weather. 

24 



1S6 REMARKS ON HYGIENE. 

The reader will now comprehend our reasons for recom- 
mending that the abdomen should be better protected by cloth- 
ing than the rest of the person, especially during the periods 
of'childhood and old age. 

There is one all-important law, which is not generally laid 
down by writers on Hygiene, and that it is desirable to impress 
as strongly as possible. *fl partial covering of any cavity, 
is much more dangerous than an entire exposure. Although 
it is highly proper that flannel should be worn next the skin 
in all cold countries and seasons, yet we well know that many 
individuals neglect the precaution with impunity. Now we 
venture the assertion, without the dread of contradiction, that 
no man can make use of a short flannel shirt that does not en- 
tirely enclose the lower part of the abdomen, or a shirt which 
occasionally rides up to the level of the top of the pelvis, with- 
out suffering severely, and often dangerously, from this partial 
covering. If young, he will be subject to attacks of inflam- 
mation of the bowels, diarrhoea, incontinence of urine, or 
strangury, for which he is totally unable to account; — and if 
old, he will be liable to similar paroxysms of rheumatism, in- 
flammations of the kidney, or other evils equally inexplica- 
ble. 

There can be no doubt that the employment of such gar- 
ments as those just mentioned, and the neglect of the princi- 
ple that partial exposures are dangerous, are frequent causes 
of the loss of human life! and it would be difficult to adduce 
a more beautiful proof of the vast importance of Hygienic de- 
tails, apparently trivial, and scarce worthy of notice. 

In order that the reader should be made fully acquainted 
with the principle on which clothing should be employed in 
protecting cavities from the effects of cold, it will be well to 
mention that the direct effect of cold on the contents of the ca- 
vities is rarely experienced in an alarming degree: it occurs 
only in cases of an approach to freezing; and is of course fatal, 
if long continued. The more important influence is an indi- 
rect one. The cold producing a contraction of the capillaries 
of the surface, and a corresponding diminution of nervous en- 
ergy in the skin, it follows that the amount of circulation and 
nervous action in the internal parts must be proportionally in- 
creased. Hence, a greater liability to diseased action! The 
truth of this explanation is beautifully proved by reversing the 
proposition. Let the stomach be occupied by digestion, or 
let the lungs or intestines be irritated by any of the usual 
causes of disease, and immediately the surface becomes chilled, 
no matter what the temperature of the surrounding air may 
be. In the first mentioned instance, the blood was driven 
from the circumference to the centre, and is best recalled by 



REMARKS ON HYGIENE. 1S7 

external applications; while in the last it is enticed from the 
surface, for the purpose of repairing internal injury, and is 
more readily replaced by remedies addressed to those parts 
which are irritated, than by any external treatment. When 
a man is chilled by exposure, the fire will warm him, but in 
the chill of an intermittent, a dose of forty drops of laudanum 
will often restore the heat of the surface in a few minutes, 
when all the blankets in the world would fail! 

The chief object of clothing is to prevent this determination 
of blood to the internal parts during slight exposures: hence, 
the importance of protecting not only the abdomen, but the 
feet also, (distant as they are from the scene of action,) when 
we desire to shield the bowels against the effects of atmosphe- 
ric changes; but on this point we shall speak hereafter. 

As we ascend the scale of nature, after passing in review 
those animals which are provided with but one internal cavi- 
ty, which generally contains alike the organs of digestion and 
respiration, we begin to observe a second cavity forming itself 
by the growth of a partition across the abdomen, converting 
it into two distinct chambers, of which the lower is the abdo- 
men proper, and contains all the organs of digestion, and the 
upper is the thorax or chest, which, in man, contains the heart 
and lungs. 

It is generally supposed that the lungs require more careful 
protection than even the abdominal viscera, but a moment's re- 
flection will at once convince us to the contrary. Nature, 
whose laws are unerring, guides us on all questions of this 
kind. She has separated the abdomen more completely from all 
direct connexion with external things, and it is only at long in- 
tervals and for short periods, that any crude extraneous sub- 
stance is permitted to act upon the stomach, — the other parts 
of the canal (in health,) being free from all contact with un- 
digested matter. On the contrary, the lungs are at all times and 
unceasingly in contact with the atmospheric air and the thou- 
sand impurities which it contains: they are liable to great and 
sudden changes of temperature in the surrounding medium, 
acting upon them both internally and externally; for the walls 
of the chest are in many places thinner, and every where less 
loaded with subcutaneous fat than those of the abdomen. 
Moreover, though the assertion may prove startling to some, 
it is not the less true that morbid changes of structure in the 
alimentary organs are vastly more important and dangerous 
than those of the lungs! The latter, indeed, are often known 
to become impervious in more than half their extent, and yet 
life may be continued for years! Still stronger proofs of a 
similar character might be adduced; but enough has been said 



1SS REMARKS ON HYGIENE. 

to show that the protection of the chest by clothing, though 
of incalculable importance, is of somewhat less consequence 
than that of the abdomen. The latter should therefore be 
somewhat more warmly clad than the former, and in this re- 
spect the dress of females is somewhat more rational than the 
male attire. 

Partial exposure of the chest is of course liable to the same 
objections which have been already urged against that of the 
abdomen; and it should be remembered that the lungs rise be- 
hind the clavicles, above what is commonly considered the 
cavity of the chest, and encroach a little on the base of the 
neck. The dress should always protect this part in cold wea- 
ther, if we desire to regulate it on philosophical principles; — 
but the rigid laws of fashion interfere to prevent a proper sys- 
tem in both the sexes. The ridiculous cravat, invented to 
conceal a deformity! and the equally absurd padded stock are 
used to convert the neck and throat into a furnace, and the 
unreasonable temperature is adroitly made to cease at either 
end, precisely where it would be most excusable to employ it; 
namely, near the tonsils above, and about the collar bones below! 
In women, on the contrary, fashion not only exposes the base 
of the neck, but also the upper part of the chest. Fortunate- 
ly, the natural tendency of such habits to run into extremes, 
bids fair, ere long, to render this partial exposure a complete 
one! It will then become comparatively innoxious! 

The next great cavity of the body is that of the head, but 
rhis appears much later in ascending the scale of nature, than 
those previously mentioned. It also requires much less care, 
— for if we except the climates distinguished by the extremes 
of heat and cold, both of which render a head-dress absolutely 
necessary; the head adapts itself with great facility to any de- 
gree of exposure. It is only requisite to avoid rendering the 
head susceptible to slight impressions by too great warmth in 
the apparel, and to shun unusual currents of air, such as the 
waving of the punkah, which has been already mentioned as 
a cause of catarrh in tropical countries. 

In proceeding to the consideration of the principles which 
should determine our mode of dressing the extremities, the 
first point of -importance which strikes us is the feeble powers 
of the inferior, when compared with the superior extremities. 
The pressure of a long column of blood on the vessels of the 
legs, and the embarrassment of the circulation from that cause, 
together with the greater distance from the centre of circu- 
lation, render the vital operations in the feet peculiarly slow; 
while the sympathies awakened by impressions on the feet 
are even more extended and important than those which arise 



REMARKS ON HYGIENE. 189 

from exposures of the superior extremities; consequently, it 
is necessary to clothe the feet more warmly than the arms, 
and a neglect of this law is often productive of great danger. 

Having now dismissed the question of the parts of the body 
which most require protection from exposure, it is proper to 
consider the nature of the substances to be employed in cloth- 
ing. 

The properties requiring the greatest degree of attention in 
the selection of tissues or other materials for clothes are, 1st. 
The degree in which the material is capable of conducting 
heat. 2nd The nature of its action on the skin. 3rd. Its po- 
rosity or power of imbibing or transmitting insensible perspi- 
ration; and 4th. Its colour and the character of its surface. 
The articles employed in dress are so various that it would be 
impossible for us to consider them in detail, and in the re- 
marks which follow, we shall confine our attention chiefly to 
the qualities of dresses composed of linen, cotton, silk, wool, 
or leather, as this list includes most of the materials in com- 
mon use. 

1st. On the conducting power of the materials. — It is very 
easy to lest the conducting power of any tissue or other arti- 
cle intended to be used as a garment, by the impression which 
it produces upon the sense of touch. Take a number of strips 
of different substances, and place them together in an apart- 
ment, until they all acquire the same temperature with the 
surrounding air. Then let each of these strips be applied, in 
succession, to the back of the hand, and it will be found that 
some of them will feel quite cold, others lukewarm, and others 
positively warm. Now these articles being all really of the 
same temperature, the apparent difference results entirely from 
the fact that some of them carry off the animal heat with more 
facility than the air, and therefore diminish the warmth of the 
surface, while others, on the contrary, have less conducting 
power than air, and thus confine the animal heat until it accu- 
mulates on the surface. 

Linen is the coldest of all the articles commonly employed 
in clothing, and is infinitely more comfortable to the skin than 
any other tissue in warm weather, and in tropical climates; 
but this quality renders it highly dangerous when used with- 
out caution, and without sufficient clothing to envelop it. In 
situations, and at seasons when the temperature of the air is 
nearly uniform, or free from sudden changes, it is both safe 
and delightful for those who are not under the necessity of 
using severe exertion, and are therefore able to avoid being 
thrown into sudden perspiration. In the middle and southern 
parts of the United States it is a proper dress for sedentary 
and idle persons, during the months of June and July, and 



190 REMARKS ON HYGIENE. 

during a part of August; but in the spring and fall, when the 
mornings and evenings are cool and the middle of the day in- 
tensely hot, it becomes improper; for the changes of the at- 
mosphere produce their action on the constitution almost in- 
stantaneously when the body is clothed in linen; and though 
many persons in the vigour of life employ the linen shirt 
with impunity at all seasons, their experience furnishes no 
evidence of the propriety of such a habit, in delicate persons, 
or those susceptible of strong impressions from without. Even 
those who have been long accustomed to this mode of dress- 
ing generally find themselves compelled to employ flannel in 
winter, and cotton in the spring and fall, before they have 
passed the meridian of life; and the principle adopted by some 
parents and masters; namely; that thin garments and linen 
next the skin, in cool weather, are among the best means of 
"hardening children" deserves to be represented as a mur- 
derous principle! 

On all tropical coasts, and in the neighbourhood of moun- 
tain ranges, where the sea-breeze or the cold air of the heights 
rushes in, after sunset, to constringe every fibre after the relax- 
ation of the day, the use of linen next the skin should always 
be avoided; and the workman in the harvest-field who comes 
in from his labour, bathed in profuse perspiration, to set himself 
in the strong draught between the kitchen door and the great 
fire-place, while demolishing his cold collation of pie, milk, 
and cider, — might almost as reasonably circulate between an 
oven and an ice-house, as to encase his broad chest in linen 
while exposed to such sudden transitions of temperature! 

In passing these strictures upon a favourite and truly de- 
lightful species of attire, we would not be understood to offer 
any objection against the luxury of linen sheets; articles with 
out the aid of which hot weather is indeed a misery! Long ere 
we retire, the occupations of the day are over, and the heat of 
our bodies, as well as the activity of our minds, is tempered 
down gradually, so that in most situations there is no danger 
of any violent change of temperature for many hours; and if 
any thing of the kind is anticipated, it is easy to protect the 
person b}^ other external covering much more completely than 
can be done during the day, when the European style of dress 
is employed. The momentary shock on leaping into bed, and 
the continued comfort attending the use of linen sheets, is in- 
deed decidedly healthful; and the abdomen and thorax, which 
require the greatest degree of protection, are secured against 
the direct effects of this mimic cold bath, while the whole body 
is invigorated by the re-action it produces. 

Next in order as an immediate application to the skin, we 
may rank the cotton cloths. Cotton is decidedly a bad con- 



REMARKS ON HYGIENE. 191 

ductor of heat, although it is less remarkable in this respect 
than silk or woollen. Though more irritating to the skin than 
the former, it is bland when compared with the latter, and fur- 
nishes us with the best defence against the diurnal and other 
slight changes of temperature of hot seasons and climates. 
Not sufficiently warm for safety in winter, it is at all other 
times the best material for garments worn next the skin under 
circumstances which render the use of linen improper. 

A peculiar property of cotton pointed out by Johnson in his 
work on tropical climates, is of so much practical importance, 
that it requires particular notice. A fresh cotton shirt excites 
perspiration in a remarkable degree, and becomes speedily 
wetted with the discharge. This does not render the wearer 
subject to a sudden chill on exposure, as is the case when linen 
is worn; but if the shirt be frequently changed, this constant 
drain from the skin soon reduces the strength, and increases 
the liability to disease. To avoid this inconvenience, which 
becomes serious in hot countries, it is best not to change the 
shirt daily, but to dry the garment during the night, and con- 
tinue to wear it for two or three days before washing. When 
once saturated with perspiration it proves much less liable to 
the objection just stated, and we have often noticed, on long 
pedestrian excursions, that a march of forty miles in a clay was 
performed with much less fatigue with a cotton shirt worn on 
the previous day, than with one fresh from the laundress. 

Cotton hosiery is very commonly worn in this country during 
the summer, and by many females during the winter also. 
The latter practice is inexcusable, and is the source of incal- 
culable mischief and destruction of life. If appearances must 
be consulted, in preference alike to comfort and safety, it is at 
least desirable that stockings of light woollen should be worn 
beneath the cotton. 

Pedestrians, soldiers, and all persons accustomed to walking 
or standing during long periods should invariably employ 
woollen hose, even in the hottest weather; as a neglect of this 
precaution is very destructive to the feet. 

Silk is at once a bad conductor of heat, and an exceedingly 
agreeable application to the skin. The perfect roundness and 
smoothness of the thread prevents it from creating the slight- 
est irritation, but the same properties enable the air to circu- 
late very freely through the pores of silken tissues, and in a 
strong breeze the wind meets with less resistance than it does 
from either linen, cotton, or woollen. The open fabrics 
of silk which are used for hosiery, shirting, &c, when used 
alone, furnish, therefore, but slender protection against expo- 
sures; but when covered by other garments which arrest the 
circulation of air between the threads, they become very warm 



192 REMARKS ON HYGIENE. 

articles of attire. Silk, therefore, is among the best articles to 
place next the skin, as an under-dress, in moderately cold 
weather; but when worn loose, or as an outer covering, it is 
very cool, and fit only for the warm seasons and climates. It 
enjoys an advantage over all the other materials which have 
been enumerated, in the freedom with which it permits the 
exit of the insensible, and the evaporation of the sensibl-e per- 
spiration; and it is also remarkably exempt from that power 
of imbibing and retaining animal effluvia, which often renders 
clothing unhealthy, or make it a vehicle for the transmission 
of contageous diseases. 

Woollens, and especially flannel, are invaluable as articles 
of dress, and the range of their usefulness is much more ex- 
tensive than is generally supposed. When used next the skin, 
they combine a sufficient power of retaining the animal heat, 
with a freedom in transmitting the insensible perspiration, and 
a mechanical action on the skin which preserves just sufficient 
glow and excitement to heighten without exhausting the vital 
energy of the surface. These properties render them of infi- 
nite value in cold and damp countries, where the vital power 
of the skin is continually depressed by the atmospheric influ- 
ence. 

But the usefulness of flannels is by no means confined to 
the colder climates; it constitutes the best over-dress for pro- 
tecting the person from the slight but dangerous vicissitudes 
of temperature in tropical countries. Being prepared of all 
degrees of fineness, it may be made into garments, loose, light, 
flowing, and airy — proving vastly more comfortable, even in 
the extreme of hot weather, than any other species of cloth, 
while at the same time it protects the wearer more perfectly 
against the ill effects of sudden draughts of air, the sea breeze, 
morning mists, &c, those fertile sources of disease between 
the tropics. 

Of the skins of animals employed in dress, little need be 
said, for except as coverings for the hands and feet, articles 
of this character are now seldom used; still it is proper to no- 
tice the buck-skin shirt and drawers, and what are termed the 
medicated hare-skins for protecting the front of the chest. 

Buck-skin is by far the warmest article which can be worn 
next the skin, and in the extremes of cold weather it is per- 
fectly delightful to the wearer. With a shirt and drawers 
well made, and covering the person completely from the mid- 
dle of the neck to the ankles, the wearer may fearlessly de\\ 
the most intense cold of our winters. It is customary to line 
garments of buck-skin with silk in order to prevent immedi- 
ate contact between the skin and the garment; but this is al- 
together unnecessary, and by no means convenient,— for the 



REMARKS ON HYGIENE. 193 

silk gives way very soon, while the buck-skin seems almost 
incapable of wear. The transmission of the insensible per- 
spiration is also more easy when it has only to pass through 
one homogeneous layer, than when several thicknesses of dif- 
ferent materials are applied. When buck-skin is worn for an 
inner garment, it should not be frequently changed, as it will 
not bear repeated washing without becoming altered in tex- 
ture, and as it preserves the surface more free from all acci- 
dental impurities from without, it may be worn for an entire 
month without any breach of personal propriety. Almost any 
degree of exposure during the winters of the temperate zone, 
may be borne with impunity by those who are clad in buck- 
skin; but the utmost caution is necessary in relinquishing its 
use on the approach of warm weather, as the sudden change 
from such garments to any of those in more general use is ex- 
tremely severe; and it is best to employ very stout flannel, or 
the thickest Canton flannel for an under-dress during some 
weeks in the spring of the year, when buck-skin has been used 
through the cold season. 

Under the name of medicated hare-skin, an article of dress 
of great value has been recently introduced. It is simply the 
skin of some species of the rabbit tribe, (the white varieties 
being commonly preferred,) tanned without removing the fur. 
The pretended medication is merely a trap to secure the po- 
pularity of the article by calling in the aid of a little mystery ! 
It is worn on the breast, with the fur next the skin, and is an 
admirable protection to those who are in the habit of leaving 
the upper part of the chest ill-guarded. To women who can- 
not or will not employ buck-skin, it acts as a delightful and 
efficient preventive against catarrhs, and materially retards the 
advance of consumption. The wearer should be careful to se- 
lect a skin large enough to cover the whole front of the chest, 
for if it be too narrow, it rather increases than diminishes the 
danger of exposure. The medicated hare-skin is usually sold 
by the druggists. 

Within the last few years, the various tissues coated with 
the varnish of India Rubber which have been introduced into 
the system of the toilet, have attracted much attention, and it 
becomes requisite for us to notice the peculiarities of this spe- 
cies of dress. 

The principal peculiarity of caouchouc is its total incapacity 
for transmitting the sensible or insensible perspiration, and 
the parallel power which it naturally possesses of cutting off en- 
tirely the access of moisture to the person from without. Pre- 
pared as this article was originally, when designed to be em- 
ployed as an article of dress, the solvents of a spirituous or 
-ethereal character employed in its application, rendered it a 

25 



194 REMARKS ON HYGIENE. 

stimulant, of great activity; and, waving the disagreeable odour 
which the solvent elicited, it became decidedly objectionable 
as an application to the skin. But numerous improvements 
have been recently made in the manufacture of India Rubber 
cloth, and the process is conducted by means of rollers without 
the aid of any solvent; the inconvenience resulting from the bad 
odour is thus completely obviated. Yet, notwithstanding these 
improvements, it is improper to use the article as an under- 
dress, for even when made into sheets, the caouchouc is found 
to act so powerfully upon the skin, that a decided eruption is 
goon produced wherever it remains long in contact. This pro- 
perty, which prohibits its employment in health, bids fair to 
render it a very valuable remedy in chronic pains, rheuma- 
tism, &c; for it acts as a slow, but powerful counter-irritant 
or revulsive. 

Even as an external dress, the India Rubber should not be 
worn on ordinary occasions; for, being impervious to all mois- 
ture, a few hours are sufficient to render the other clothing 
damp and clammy with the precipitated effluvia of the person, 
which is not permitted to escape by evaporation. But, on all 
occasions when we are compelled to remain for a time ex- 
posed to unusual moisture, such as the mists of the morning 
and evening in cool weather, or when compelled to wade in 
the water, as in fishing or hunting, we can find no more per- 
fect protection than a partial or complete over-dress of India 
Rubber cloth. 

Having now completed a rapid review of the parts of the 
body which most require protection, and the character of the 
various kinds of material generally employed for dressing, we 
will close the present section with a few general remarks on 
the application of the principles laid down — for to descend 
into particulars, would be impossible within any reasonable 
limits. 

Children, and old persons, require much warmer apparel 
than persons in middle life. 

Exposures to sudden changes of temperature are dangerous 
every where; but cold, or even an air merely chilly, when 
combined with much moisture, is vastly more dangerous than 
when the atmosphere is dry. 

Slight changes of temperature are much more dangerous in 
tropical climates, and in summer, than in winter, and in colder 
regions. 

Exposure about sun-set, and before sun-rise, ought to be 
avoided by the delicate with more caution than is requisite 
during the day time or late at night; — and when any febrile 
epidemic is prevalent, this rule should be observed by all. 

Undue warmth of covering at night, in hot weather, is pe- 



REMARKS ON HYGIENE. 195 

culiarly enervating, for it is then that the system is in the best 
condition for enduring, without danger, a moderate and invi- 
gorating temperature. But when the nights are subject to sud- 
den changes, as they always are in tiie neighbourhood of moun- 
tains, it is proper that thin blanketing or some other wool- 
len covering should be used above the sheets, and a ne- 
glect of this precaution has cost the lives of many invalids in 
situations otherwise well calculated to restore their health. 

In extremely cold weather, the covering of the night re- 
quires to be much warmer than that of the day. 

Warm clothing to the feet and lower extremities generally 
is one of the best of all preservatives against the ill effect of 
sudden exposure. 

With the foregoing general rules once fairly impressed on 
the mind, the regulation of the dress in various situations and 
in persons of different constitutions, may be left with safety 
to the intelligence of the individual most interested. 

Of Cleanliness. — We have spoken of the ill effects of cloth- 
ing which, like India Rubber, is impervious to the sensible 
and insensible perspiration, but there is another mode in which 
the same arrest or retardation of the discharges of the skin is 
much more frequently effected. Uncleanliness. — Let not the 
fair or the fastidious reader be shocked by the allusion ! Doubt- 
lessly all those who move in the middle or higher walks will 
indignantly exclaim against a lecture upon a subject which it 
is deemed an insult to suppose neglected! We do not desire 
to offend, but our duty calls upon us to proceed. Of the ac- 
tual accumulation of what is called dirt upon the surface of 
the body, little need be said; all but a few peculiar theorists 
on the training of children, to whose opinion we have alrea- 
dy replied, are well aware that neglect on this point is both un- 
healthy and disgusting: but it may be well to mention, in 
passing, that the scrofulous and pulmonary diseases of the in- 
digent and the slave, are rendered vastly more numerous by 
this neglect. The introduction of the public baths of the Ro- 
mans would prove a noble charity at the north, and a matter 
of serious economy to the southern planter. 

Let us pass to a subject less generally understood! — In the 
chapters on Anatomy and Physiology, the cuticle or scarf-skin 
has been described as an envelope not endued with vitality — 
a mere crust depending on the surface, and capable of trans- 
mitting moisture or other matters very slowl- It was de- 
scribed as thick and massive on parts designed to bear pres- 
sure, but peculiarly thin and delicate in certain places. Now 
it is perfectly well known to physicians that where the cuticle 
ifc thinnest, there the sensible and insensible perspiration flow 
most readily; there substances applied to the surface are most 



196 REMARKS ON HYGIENE. 

rapidly absorbed into the body; and there also external agents 
act most promptly upon the nervous system. On the inside- 
of .the arms and thighs mercurial ointment salivates soonest; 
on the back of the hand, the forehead, arm-pit, and groin, ex- 
ercise first calls out the flood of perspiration, and blistering 
plasters raise the most speedy vesication. Every thing, then 7 
that tends to increase unduly the quantity of cuticle, disturbs 
the freedom of the skin in the performance of its active func- 
tions. The most important functions of the skin are the tran- 
spiration of moisture, &c, which removes unnecessary sub- 
stances from the circulation; and absorption, which assists. in 
changing the qualities of the blood, and, under certain circum- 
stances, appears to contribute even to the nutrition of the body. 
If the transpiration be checked by the excess of cuticle, the 
lungs and kidneys, (the two other organs which separate the 
mass of the surplus fluids from the system,) are called upon 
for greatly increased exertions, and are consequently rendered 
much more liable to disease. 

The human cuticle is not a permanent covering, but an in- 
crustation of horny matter continually produced by the true 
skin, and intended to be as continually worn away by fric- 
tion; but if protected from accidents by clothing, and its con- 
dition neglected, it is not worn away with sufficient rapidity, 
from most parts of the person; — on the contrary, it accumu- 
lates until the insensible perspiration penetrates it with diffi- 
culty, and the health is injured. To illustrate my meaning 
more fully, let us suppose a person remarkably careful of the 
appearance of face, hands, and nails, and prodigal of soap, 
whose weekly ablutions of the whole person are never neglect- 
ed, but who employs a soft towel, and considers the principal 
object to be accomplished by wiping, to be the removal of 
moisture. Take this individual when fresh from the bath and 
"clean," — rub him down well with a coarse towel, particu- 
larly on the back, the shoulders, the front, and the inside of 
the limbs, — then plunge both patient and towel into a fresh 
bath, and the water will be instantly rendered turbid or milky 
with the flocculi of scarf-skin, the most unhealthful of all dirt, 
washed from the surface of this fastidious personage! 

It is of the utmost importance, especially with the delicate 
and sedentary, that a rough towel or the flesh-brush should be 
employed in bathing, and that it should be thoroughly applied 
to all parts of the person. This is even more conducive to 
cleanliness, good health, and spirits, than the most liberal use 
of soap. 

At certain periods of the year, quadrupeds shed their hair; 
snakes, their skin; deer, their horns; and birds, their feathers; 
— mam also, sheds his coat in summer! It may be seen peal- 



REMARKS ON HYGIENE. 197 

ing off in flakes from the forehead, the cheeks, and the backs 
of the hands. The season of this quasi moulting, is that at 
which such ablutions as are here described become most ne- 
cessary. 

Without entering at any length upon the subject of baths, 
we will here close the section with a strong expression of dis- 
sent from the opinion of those who approve of bathing soon 
after a meal. At such times, the cold bath does injury by 
driving too great a quantity of blood toward the bowels, and 
the hot-bath is equally hurtful by drawing too much of the 
circulating fluid to the surface; and thus both alike disturb di- 
gestion, the former by oppressing, and the latter by debili- 
tating the stomach. 



OF AIR AND MOISTURE. 

The reader is already sufficiently well acquainted with the 
importance of the lungs in the animal economy, and will be 
fully prepared to appreciate the importance of every thing 
which relates to the quality of the air admitted into those ex- 
tensive organs. 

As presenting a vast absorbing surface, possessed of the 
highest possible degree of vascularity and vitality, the cavity 
of the lungs must be open to the most rapid action of poison- 
ous substances, when they find admittance with the air neces- 
sary to the support of life. It is true that most of the gaseous 
or fluid substances which would produce rapid death by their 
presence in the lungs, are, when concentrated, refused admis- 
sion, because their presence in the throat occasions an instan- 
taneous spasm which closes the glottis, or opening of the la- 
rynx, (see p. 96,) and death, if it occurs, is caused by suffo- 
cation before the noxious article finds its way to the lungs. 
Thus, if a man fall into a brewer's vat when filled with strong 
carbonic acid gas, or if he fall into the water and is drowned^ 
he dies before much of the gas has penetrated the larynx, and 
before any of the water has flowed into the lungs. It is only 
after death that the air passages become in a considerable de- 
gree filled by the foreign fluid. On the contrary, when poi- 
sonous gases are mixed with a considerable portion of atmo- 
spheric air, they find a much more ready access to the lungs, 
and consequently produce their peculiar effects upon the con- 
stitution. Some poisons, such as the fumes of ether, do not 
occasion spasm, and find entrance in a much more concen- 
trated shape. 

If a person immersed in water, or in any of the gases which 
close the glottis, be drawn from that situation before or very 



19S REMARKS ON HYGIENE. 

soon after the spasm has been relaxed by the approach of 
death, there is always a reasonable hope of restoring the sus- 
pended animation, and if the patient recover at all, the health 
is seldom seriously injured. The cases resemble the effects 
of hanging, in most respects, except in the absence of the me- 
chanical mischief done by the rope. When, on the contrary, 
the immersion has taken place in a diluted mixture of a nox- 
ious gas with atmospheric air, serious disease or death may 
follow after a considerable interval of time, even when the 
suspension of animation has been by no means complete. 
Among fatal accidents of this nature within the memory of 
the writer, are several in which the fumes of burning straw, 
the damp of wells, mixtures of air and carbonic acid, &c, have 
occasioned death, when the motion of the heart, occasional res- 
piration, and sometimes even traces of consciousness, have 
continued throughout the whole period of exposure to the poi- 
son, and afterwards. The strongest of these cases was that of 
an unfortunate fellow-student, who died in a few weeks from 
the effects of chlorine gas, which he had imprudently inhaled 
in testing the smell of the fluid in the lecture-room. After an 
approach to fainting for a few moments, this gentleman rose 
and left the room, to which he never returned! If the admix- 
ture of considerable quantities of impurity with the air we 
breathe is thus capable of producing terrible effects, it stands 
to reason that even portions more minute, such as it is impos- 
sible to avoid, must exert considerable influence upon the 
health; and if farther proof be required of the extreme suscep- 
tibility of the lungs to impressions from without, it is only 
necessary to refer to the intoxicating effects of the hookah, 
and the dreadful mischief which frequently follows the silly 
practice of inhaling the fumes of ether. 

These remarks are made, to aw r aken the attention of the 
reader to the influence of minute peculiarities in the character 
of the atmospheric medium in which we are placed; but their 
practical application must be directed in a great degree by the 
good sense of the reader; for it is utterly impossible to exa- 
mine in detail the various dangers to which we are constantly 
exposed in regard (o the properties of the air we breathe, and 
the mode in which we may guard against them. In the pre- 
sent work our remarks on this subject will be chiefly confined 
to some peculiarities in the physiological effects of air, result- 
ing from states of temperature, moisture, and elevation; dwell- 
ing chiefly on such as have relation to the location, ventilation, 
and domestic arrangements of dwelling-houses- 

From the days of Hippocrates, the father of medicine, down 
to very recent times, the prevalence of epidemics has been at- 
tributed to the action of poisonous effluvia contained in the air, 



REMARKS ON HYGIENE. 199 

and supposed to be derived from the decomposition of vegeta- 
ble and animal matter, and the emanations from the bodies of 
the sick. These effluvia have been termed miasmata, and 
each peculiar epidemic has been considered the result of its 
own especial miasm. The progress of Physiology, and espe- 
cially the increased knowledge of nervous stimuli, and the ad- 
vance of electro-magnetism, have shaken the foundations of 
this theory, or rather hypothesis, of miasm. The attempt is 
seldom made by medical philosophers of the present day to 
account for the varieties of fevers and other epidemic diseases, 
on the supposition that each variety is produced by a peculiar 
miasm; for it is now commonly conceded that the rapid and 
general epidemics owe their origin to causes more remote than 
any mere adulterations of the air. The term " telluric influ- 
ence" has of late been extensively employed to express this 
remote predisposing cause of disease, which seems, at intervals, 
to modify the nervous action or vital power of the whole ani- 
mate creation, and enables the same exciting causes to pro- 
duce various effects at different times; but this term is really 
a mere name for what we do not understand; and like all other 
words substituted for things, has done considerable mischief. 
Some theorists now contend that no peculiar effluvia are ne- 
cessary to the production of fevers, and that the only circum- 
stances connected with the condition of the air which exert 
any material influence in exciting such diseases, are tempera- 
ture and moisture! But granting all the vast importance of 
these circumstances, the whole history of endemic diseases, 
or those appearing regularly or constantly in certain situations, 
should demonstrate in a manner quite satisfactory to the minds 
of philosophical inquirers, that, independently of all epidemic 
changes, and all varieties of temperature and moisture, there 
are vitiations of the air, resulting from animal and vegetable 
decomposition, fully capable of producing febrile disease. Mi- 
asms thus engendered may be blown about by the winds, and 
may thus do mischief at a distance from the place of their for- 
mation; they may be elevated to the upper regions by the 
heat of the sun, and precipitated by the coolness and dews of 
evening. Truly, these miasmatic exhalations will not explain 
the differences between epidemics or the mode in which they 
are extended — for these diseases often spread in the face of 
the wind, and in a manner which cannot be explained by any 
known atmospheric revolution. But miasmata are not the 
less certain causes of disease, because they do not determine 
the nature of the disease which they generate. They make 
the patient sick, and leave it to the peculiarities of climate and 
location, or the nature of the reigning epidemic to determine 
the character of that sickness. The same miasm which in 



200 REMARKS ON HYGIENE. 

one place excites an intermittent fever, shall, in another, pre- 
voke a dysentery! That which in one year brings on a yel- 
low fever, may, in another, give rise to Asiatic cholera! 

It follows, then, that the location and ventilation of a resi- 
dence is a matter of the utmost importance to the health of 
the occupants, and that after the temperature and the degree 
of moisture are duly regulated, it is proper to guard against 
miasms with the greatest care. 

The effluvia generated by vegetable decomposition are be- 
lieved to be readily precipitated by moisture; hence the dews 
of the morning and evening, the mists of the spring, and more 
especially the autumns, and the first showers of the rainy sea- 
son in tropical climates, are rendered peculiarly dangerous to 
health, because they apply, both to the skin and to the surface 
of the lungs, a watery vapour charged with miasmatic exha- 
lations. By following the diurnal variations of temperature, 
we shall at once perceive the reason why exposures in the 
middle of the day and late at night are so much less hurtful 
than those to which we are subjected during the morning and 
evening hours. At night, in most situations, the free mois- 
ture of the air, together with the miasm, is chiefly precipitated 
upon the ground, so that we walk over the prostrate enemy. 
At mid-day, on the contrary, the unhealthy effluvia are imme- 
diately heated and rarefied by the sun's rays, so that they as- 
cend, with the air, into an elevated region, leaving us to walk 
in safety under a canopy of disease! 

Our country contains many valleys which are proverbial for 
their unhealthiness. The traveller should never pass these 
districts until the sun has illuminated, for a few minutes, the 
whole extent of the plain, or, in other words, until the curtain 
of poisoned air has been lifted from the low grounds by the 
warmth of day. If compelled to pass the night in such a re- 
gion, he should at least retreat to shelter before the sun has 
set, and protect himself by artificial means against the dangers 
to which he is exposed by nature. 

It appears probable, (to speak in the most cautious manner,) 
that vegetation — which, in its decay, produces by far the great- 
est amount of miasm — when vigorous, subsists upon and de- 
stroys it. This result is no doubt in a great degree owing to 
the action of the roots in absorbing the elements of decayed 
plants beneath the soil, but it is at least equally certain that 
the stems and leaves of living vegetables inhale the same ef- 
fluvia to an incalculable extent. Our American forests are al- 
most universally remarkable for their healthiness in their pri- 
mitive state. The most noxious portion of the gases elimi- 
nated from the dead leaves is immediately absorbed by their 
living successors. The tree, the vine, the shrub — even the 



REMARKS ON HYGIENE. 201 

grave festoons of moss, and the humbler lichens and mush- 
rooms, all contribute to preserve the fitness of these gloomy 
wilds for the residence of savage or adventurous men. But 
when the sturdy settler grapples with the Majesty of nature 
in these, her chosen haunts, deeply does she revenge the de- 
secration of her altars! The green robe has scarcely fallen 
from the girdled tree ere the demon of disease is busy with 
his victims. The summer sun plays fiereely on the damp 
soil, in whose bosom the elements of destruction have slept 
innoxiously for ages. They rise, and the unthinking farmer 
whose first effort destroys all vestages of tree or plant around 
his log hut or his boarded cabin, lies wholly at their mercy! 
The pale planter of the low grounds goes shuddering to his 
labour with yellow cheek and watery eye. The more vigo- 
rous woodsman of the height sinks under the slow sapping of 
•hepatic diseases, from which his very cattle cannot escape!* 
and the denizen of the nascent city of the south-west, falls sud- 
denly beneath the terrible plague of the tropics, — the dreaded 
yellow fever! But these evils are, in most situations, merely 
temporary. In a few years a large proportion of the destruet- 
able vegetable matter in the soil is dissipated. Sometimes, 
though, alas! too rarely in our country, a few young trees are 
planted round the dwelling, and finally, the harvest, the cul- 
tivated garden, and the fields of grass supply the place of the 
primeval forest and destroy the remaining miasm, as it is 
formed. The offended dignity of nature is appeased, and Hy- 
giea reigns once more over a hardy yeomanry, whose dames 
and daughters display the roses of their well rounded cheeks, 
glowing through the nut-brown tint of health! 

Almost the only places in which the evil influence of mi- 
asmatic exhalations resist more permanently the effect of those 
causes which have just been pointed out, are the broad and 
rich bottoms of those rivers which periodically overflow their 
banks, increasing the fertility of the earth at the expense of 
the health and life of the cultivator. In such situations the 
depth of the soil renders it incapable of exhaustion, and 
the annual addition of destructible matter exceeds the de- 
mands of the most vigorous vegitation. Here, then, the 
sources of disease are continually exerting their energies, and 
ages may prove necessary to paralyze their power. The 
strongest natural examples of this character, in our country, 

* During a residence of a year in north-western Pennsylvania, the writer was 
astonished to find ample verification of a fact mentioned to him by an intelli- 
gent settler, namely, that all the cattle of the district, though thriving in ap- 
pearance, were affected by softening, abscess, or worms in the liver. He exa- 
mined many oxen destined for the table, and found them invariably in the con- 
dition described. 

26 



202 REMARKS ON HYGIENE. 

are seen in the low lands of the Ohio and Mississippi; — the 
most remarkable artificial instances may be found in the rice 
plantations of the South. 

On a smaller scale, a certain degree of permanence is given 
to the unhealthiness of districts by the vicinity of extensive 
swamps in which the water is occasionally raised by unusual 
rains, the existence of considerable flats on the margin of fresh 
water estuaries, and even the construction of mildams in level 
countries. The description o^ the artificial means by which 
these evils may be counteracted is foreign to the purpose of 
this work, but it is right to mention that for several years af- 
ter the draining or embankment of such tracts, the unhealthi- 
ness of the surrounding country is generally increased by the di- 
rect action of the sun on the remains of vegetation; though the 
ultimate benefit far outweighs this temporary ill consequence. 

Even after the entire clearing of a district of country, thouglv 
the excessive miasmata may be no longer generated, the more 
fertile portions still give rise to poisonous effluvia — insufficient, 
perhaps, to engender disease under ordinary circumstances, — 
but powerful enough to produce very serious consequences 
when epidemics prevail in the neighbourhood. Effects of this 
character are so frequently observed, that it might almost be 
established as a general rule that the ?nore fertile the soil, the 
more sickly is the district; although by an apparent contra- 
diction, the vigour of vegetation is the chief protection of hu- 
man life in such situations! The settler should remember 
that " bane and antidote are both before him" and the ap- 
plication of philosophical principles to the selection of a suita- 
ble residence is every where important. 

The first point to be considered in the location of a dwel- 
ling-house, is its elevation. It should always be placed as high 
above the level of the neighbouring water-courses as circum- 
stances will permit. By this precaution we secure ourselves,. 
in a considerable degree, against the influence of miasm in 
its most concentrated form, and that in which it acts at the 
greatest advantage; namely; when held in solution by the moist 
exhalations or diurnal mists of the low grounds. It is a 
fact well known in tropical and swampy countries, such as 
the Dutch East India settlements and the delta of the Gan- 
ges, that the second story of a house is vastly more healthy as 
a residence than the lower rooms; and there are two situa- 
tions in temperate climates, in which attention to this circum- 
stance might prevent much misery and loss of life. 1st. In 
the country; when houses are built on low or inundated lands 
where endemic fevers prevail, there is not only a greater 
chance of escaping an attack when the family is located on the 
second floor, but the disease,, if it should appear, is often much 



REMARKS ON HYGIENE. 203 

more manageable in the upper rooms. 2d. In cities, where 
the diseases of childhood — and especially the cholera infantum, 
that terrible scourge of infants which often yields immediate- 
ly to the influence of country air, when all other measures 
fail, — these diseases, I say, are often cured in the second story 
of a dwelling, in cases in which such a result could not possi- 
bly occur if the little patients were confined below. The only 
exception to this rule is found in houses with thin and unpro- 
tected roofs, such as are usually found in America, where do- 
mestic architecture is neither adapted to the climate of the 
torrid, nor to that of the frigid zone, though our climate, in 
most places, presents alternately the extremes of both! The 
upper story is too frequently placed under the immediate in- 
fluence of the heat of the roof in summer, when the direct rays 
of the sun convert it into an oven, the heat of which is scarce- 
ly tempered by the interposition of a low and ill ventilated 
attic or loft. We have had occasion to witness, in several 
cases, the occurrence of the most severe and rapid fevers of 
hot climates, produced artificially in temperate districts, by the 
increase of temperature resulting from this obvious and gross 
error in the construction of buildings. The genuine malig- 
nant cholera, the concealed abscess of the liver, the inveterate 
bloody dysentery, the spontaneous lock-jaw, &c, complaints 
familiar to those who have practised in Batavia and Calcutta, 
have been observed, from time to time, in the ill-constructed 
buildings about the brick-ponds in the environs of Philadel- 
phia; but we have never met with cases of this character, ex- 
cept during the prevalence of epidemics, or in patients who 
are lodged within the direct influence of a heated-roof.* 

Having laid down a general rule with regard to the import- 
ance of an elevated site for dwellings, the next point of inte- 
rest is the form of the ground plot, and the nature of the soil 
on which the building, the garden, &c, are located. Every 
precaution should be observed in avoiding the presence of un- 
due dampness, on the accumulation of decaying vegetable mat- 

* It is really astonishing 1 that the evil effects of the usual arrangement of the 
roofs of dwelling-houses have been so generally overlooked! The remedy is 
very simple. A few orifices beneath the eves to admit the external air between 
the shingles and the ceiling or floor of the loft, together with a couple of co- 
vered ventilators on the ridge of the roof, would at once establish a continued 
current of air in warm weather, and the surplus heat would thus be conveyed 
away by an apparatus put in motion by itself. This plan could be prevented 
from producing any inconvenience in colder weather, by simply closing the ven- 
tilators; and, in the dead of winter, the orifices beneath the eves might also be 
plugged up if necessary, and thus the residents would be possessed of ready 
means for moderating both the heat of summer and the cold of winter, in the 
■upper stories of their dwellings. 



204 REMARKS ON HYGIENE. 

ter in the immediate vicinity of the house. The ground should 
be naturally drained, as far as is consistent with fertility. Nei- 
th'er stagnant ponds, nor water-courses subject to irregular 
floods, should be near, and the foundations of the building 
should be decidedly higher than any neighbouring water level. 
Unfortunate necessity can alone excuse the location of a house 
upon a substratum of clay, and such a site can never be ren- 
dered healthful but by artificial draining, — a plan far too ex- 
pensive for general adoption in agricultural districts, unless 
the clay should be found to overlay a stratum of gravel. 

There are many wide tracts of fertile country where this 
rule cannot be observed, as the geological structure of the 
neighbouring rocks converts these districts into what are com- 
monly styled basins, and draining is then rendered extremely 
difficult or absolutely impossible. 

The form of the neighbouring heights; and the prevalent 
course of the vernal and autumnal winds should always be con- 
sulted in the selection of a residence.- 

East of the Allegheny range of mountains the breezes of the 
spring and autumn are generally from the south and west; con- 
sequently, it is much safer to reside on the south and west mar- 
gins of water-courses and swamps, than to be located to the 
north and east of them; for, in the former case, the miasms arc 
blown away from the dwelling, while in the latter, they are 
continually directed towards it. 

In many places, the heights which border upon rivers and 
low grounds, are arranged in such a manner as to arrest the 
souther!}' breezes, with the miasms which accompanv them, 
and give them a northern direction along the intervening gul- 
lies, often concentrating the miasms and inundating narrow 
tracts of land in more elevated, and apparently healthful posi- 
tions, far removed from the source of the poisonous effluvia. 
The heights above Fairmount produce this effect in a verv ob- 
vious manner; the miasms of the neck below Philadelphia are 
driven by the south wind up the Schuylkill, and striking against 
the hills just mentioned, are driven across the ridge between 
the Schuylkill and the Delaware, in a direction almost at right 
angles to the wind, often carrying disease over a narrow belt 
of highland, while the inhabitants of all the surrounding coun- 
try are in the enjoyment of comparative health. Such situa- 
tions should be carefully avoided by settlers when circum- 
stances allow them a chance of selection. 

One of the greatest protections against the ill effects of mi- 
asm is a row of young and vigorous trees, near the dwelling, 
which should always be planted at the distance of a few hun- 
dred feet on the side next the principal source of the poison. 



REMARKS ON HYGIENE. 205 

With a few remarks on certain means of regulating Lhe tem- 
perature and moisture of dwellings, which appear not well un- 
derstood amongst us, we will close the present section. 

In England every little cottage is surrounded wilh verdure, 
The honey-suckle, the eglantine, and the clematis intwine 
their brandies around the door-way and form festoons above 
every window, while the ivy covers the blank wall with the 
best of all protections against the rays of a basking sun. How 
barren and cheerless in comparison is the aspect of those un- 
meaning piles of logs, boards or bricks, so often in our land 
miscalled a home! But taste and beauty are not the chief re- 
commendation of this species of ornament. Waving the in- 
estimable moral advantages of cheerfulness, and that expansion 
of heart, which a fondness for the gems of Flora invariably 
bestows, the horticulture of cottages is a subject of great hy- 
gienic importance. A dense mass of foliage covering the walls 
of a building in summer, reduces the excessive heat within 
doors, and equalises the temperature of the day and the night. 
In this manner it lessens the risks of disease, and renders an 
attack less dangerous. The ivy, so commonly employed in 
Europe, where families remain fixed in one situation for many 
generations, is a plant of very slow growth, and entirely unfit- 
ted for the wants of our restless and ever-changing country- 
men. It is also liable to another serious objection, — that of 
rendering walls damp, and destroying our shingle roofs. But 
nature has given us a vine which grows in great profusion in 
all our forests, most admirably adapted to the purpose of pro- 
tecting houses, whether built of bricks or wood. It is the 
common creeper, (ampilopsis amerieana,) often mistaken for 
the poison vine, from which it differs in having five leaflets, 
instead of three, upon each footstalk, and in adhering to sur- 
faces by means of long tendrils with terminal suckers, instead 
of bundless of short roots shooting directly from the stem. 

This plant will often cover the entire side of the largest 
houses in four or live years, it turns much of the rain, and im- 
bibes the atmospheric moisture, rendering the wall peculiarly 
dry. It will not adhere to the painted eves nor to the frames 
of windows, from which its long branches sweep downwards, 
forming graceful festoons and curtains. The general intro- 
duction of this plant would add vastly to the beauty, but still 
more to the health of the country. 

The manner in which too much moisture in the air pro- 
motes disease, has been sufficiently described already, and it 
is in the mornings and evenings, during the moderate weather 
of the spring and fall, when miasms are most rife, that the 
moisture of the air is greatest. 

Those periods, then, require the most careful attention to 



20G REMARKS ON HYGIENE. 

be paid to the artificial temperature of dwellings. When air 
is heated it unites with a larger portion of moisture, rendering 
it comparatively innoxious. Hence, whenever the tempera- 
ture of the mornings and evenings becomes suddenly dimi- 
nished, fires should be lighted in the sitting room, and the 
members of the family should be removed as much as possi- 
ble from all exposure, from sunset until ten o'clock, and from 
daylight until after the morning meal. 

By strict attention to the details pointed out in this section, 
particular families have escaped for years the encroachments 
of miasmatic disease, though resident in the midst of districts 
suffering under the most terrible endemics. Instances have 
been witnessed among the fens of Italy, the fogs of Holland, 
and the fertile bottoms of our own sea-like rivers. 



OF EXERCISE. 

The advantages which flow from exercise are so universally- 
advocated in town and country, palace and hovel, that it seems 
almost a work of supererogation to speak of them here. A 
little inquiry, however, will convince the observer that much 
as healthful exercise is praised it is but little understood. If 
we attempt to advise a dyspeptic shoemaker that he stands in 
need of free exercise to remove his disease, he will probably 
display his well developed arms and broad shoulders, and ne- 
glecting his slender or dropsical legs, and his sallow or swelled 
countenance, will triumphantly prove your ignorance by in- 
forming you that he works from morning till night, and re- 
tires to bed exhausted with fatigue! In many, this will ex- 
cite a smile, but it is easy to quote examples of the same kind 
of reasoning in those whose wealth and opportunities should 
teach them better. The merchant's salesman, whose daily du- 
ties call for continued physical exertion, in superintending if 
not immediately executing the removal of packages and goods 
from place to place, considers himself exempt from all charge 
of neglecting exercise, forgetful of the fact that free air is ne- 
cessary to the revivication of the blood, which is driven in a 
rapid current through the veins whenever we use exertion, 
but which cannot supply the force or vital energy required to 
render exercise serviceable, without a constant and increased 
supply of the purest air. By the neglect of this supply, exer- 
cise instead of increasing the energy of the system, is convert- 
ed into a mere means of useless exhaustion. Equally irra- 
tional is the practice of many well-meaning parents, (some- 
times countenanced by the physician,) of confining the exer- 
cises of their daughters to the duties of a household, — under 



REMARKS ON HYGIENE. 20 7 

improper notions of cultivating domesticity. How often, in- 
deed, do we see poor, pale, etiolated girls, with swelled feet, 
haggard looks, and attenuated extremities, but with broad, 
round shoulders, unduly developed by making beds and scrub- 
bing furniture, yet deprived of the breath of Heaven and the 
cheerfulness of society, under the idea that woman's duties 
should be centred in her home, and that exercise and free- 
dom from improper exposures are the best securities against 
the loss of health and the deterioration of morals! Annually 
are numerous victims among the wealthy and the lovely sa- 
crificed to this preposterous application of laws in themselves 
correct! 

Exercise, to be serviceable, must be taken in the open air, 
and it should never be carried so far as to produce exhaus- 
tion. 

Those exertions which call for the action of particular sets 
of muscles, if long continued without change, invariably tend 
to produce deformity. From this cause result those peculiari- 
ties of form which characterize particular trades — and it should 
not be forgotten that these peculiarities are invariably marks 
of irregular nutrition, and consequently increase the liability 
to certain diseases. Almost every trade has some besetting 
affection which attacks its followers more frequently than other 
men. 

In order, then, that muscular activity, (to which the term 
exercise is commonly restricted,) should be made conducive 
to health, it is necessary that all the muscles should be em- 
ployed so frequently as to give each set its proper develop- 
ment and to preserve the balance of the system. Deformities 
resulting from the undue or deficient exercise of particular 
muscles are almost always curable by systematic exertion — 
but so little are the principles upon which exercise should be 
regulated, understood by the mass of society, and even by those 
physicians who seldom encounter surgical cases, that most of 
the popular modes of attempting the correction of such evils, 
have a decided tendency to increase them. Thus, if a girl be 
round-shouldered, or given to stooping, owing to debility of 
the muscles of the back, or too great development of those on 
the front of the chest, her parents apply corsets or braces, 
which by supporting the head and shoulders artificially, pro- 
duce still greater weakness of the back for want of use; she 
is then, perhaps, directed to scrub furniture to invigorate her 
constitution, by which means the anterior muscles are ren- 
dered still stronger, so that the deformity is rapidly increased 
by two different processes, both instituted for its cure! The 
only rational remedy for stooping is the frequent application 
of a force which tends to draw or thrust the shoulders or head 



208 REMARKS ON HYGIENE. 

still farther forward; for the necessary resistance to this force 
will always increase the tone and size of the weakened mus- 
cles; and the only precautions necessary in employing this 
principle in all cases where there exists no serious disease of 
the bones, are, 1st. to avoid fatiguing the weakened muscles 
by continuing their action too long, for this will cause a loss 
of power; and secondly, to allow sufficient rest between the 
exercises. This latter precaution requires one word of com- 
ment. It is not during the actual exertion of any organ that 
its strength is increased — but stimulation produced by the ex- 
ertion notifies the system, (if we may be permitted this personi- 
fication) that additional nutrition is necessary in that part to 
enable it to meet the demands upon it, which, having been 
made once and again, are likely to be repeated frequently. 

A horse, or a man, on a long journey, actually loses flesh; 
but the journey once completed, and rest wil-h a liberal diet 
allowed, he rapidly increases in strength and size.* It Is 
during the rest which follows exercise, that the muscles be- 
come enlarged and strengthened. It has been alread] 
plained in a former chapter, that no part can retain its ener- 
gies if constantly exerted; or, in other words, if acted upon by 
a constant force. Hence, excessive may be occasion- 

ally employed with advantage in certain surgical cases where 
the exhaustion of a muscle becomes desirable; but this subject 
is placed beyond the domain of Hygiene.t 

In the foregoing remarks the reader will find the elements 
of the theory of gymnastics, but it would be folly to attempt 
to describe the applications of this much neglected art, within 
the limits of such a work as the present. The knowledge and 
intelligence of the mo V accomplished surgeon may often be 
employed in determining the proper course oi for 

unusual cases, and with a degree of benefit for which no mo- 
ney can compensate; for the management of such cases often 
requires an extent and accuracy of anatomical and p! 
cal research which can only be effected by professional men 
of the highest qualifications. But the common good sense of 
mankind will enable all to apply the principles laid down, to 
the every-day business of life, and to that good sense we will 
now commit the subject, after a few remarks upon the folly 
of those who oppose some of the most useful con- 

sequence of the evils following their abuse. 

There are certain sectarians, and many conscientious indi- 

* This idea, carried out by the physiologist, would probably explain the whole 
theory of habit, and in conjunction with the influence of hereditary pec i 
ties, would go far to explain the apparent varieties of most of the races of man- 
kind. 

j- Surgeons will perceive that extension in luxations acts on this principle. 



REMARKS ON HYGIENE. 209 

viduals who exclaim against particular amusements on account 
of the evils to which they are supposed to lead, — though those 
evils have no direct connexion whatever with these sports. 
"Late hours and suppers are in the highest degree injurious. 
Dancing leads to late hours and suppers, — therefore, dancing 
is in the highest degree injurious." Such is the logic by 
which the most innocent pastimes are frequently attacked, but 
when such things are regarded with the calm eye of reason, 
there will be found no connexion between dancing and dis- 
sipation — fencing and ferocity — boxing and blackguardism, 
other than that which is presented by their initial letters! 
The time occupied in the acquisition of these accomplishments, 
the supposed waste of which induces many worthy people to 
oppose them, is in reality well spent, for it is occupied in re- 
ducing to a science the proper exercise of most of the muscles 
of the body. These arts are among the most important means 
of health, muscular vigour, grace, and accuracy of movement; 
and the practice of them, rightly regulated, conduces alike to 
the powers and safety of the sailor and the hunter on the 
one hand, and to the skill and delicacy of touch of the artist 
and the operating surgeon on the other. The public health 
would be incalculably promoted by the foundation of well or- 
ganized gymnasia in every considerable school and town; — 
and even on large plantations the trifling expense attending 
the necessary fixtures would be amply compensated by the 
increased productiveness of labour, and the cheerfulness of 
servants. This last position may seem strange to many, for 
the fatiguing labours of the plough or the scythe might natu- 
rally be supposed to destroy all zest for unnecessary exertion 
on the part of the agricultural labourer; but the slightest ob- 
servation of the habits of the farmer's boy will convince us 
that athletic exercises are sought with avidity even as a relax- 
ation from the severe discipline of the harvest field! and the 
reason is obvious. Running, leaping, the games of prison bars, 
wicket, fives, &c, call into action all those muscles which are 
unemployed in ordinary agricultural labour; thus acting as an 
actual relief to the exhausted organs according to the laws of 
counter-irritation, and preventing, also, the deformity which 
inevitably results from ill-regulated labour. 

The influence of voluntary exercise upon the mind, and the 
physiological reaction of the mind upon the body, render 
these sports infinitely more conducive to health, than the ef- 
forts which are made in the simple discharge of duty; so that 
in choosing an operative in business, it is one of the best of 
rules to select the youth who plays best, for he will be found 
almost always to work best! His occasional truantship will 

27 



210 REMARKS ON HYGIENE. 

be more than compensated by his greater availability while 
on duty. 

'Muscular exercise, as a counter-irritant, now requires a pass- 
ing notice. It is in this capacity that it acts as an antidote to 
dyspepsia. The increase of nutrition, and, consequently, of 
vital energy in so large a portion of the body as the muscular 
system, must necessarily tend to lessen very materially the 
undue excitement of any internal organ, such as the stomach 
in dyspepsia, but it is a mistaken notion that those who lead 
an active life are entirely protected from this distressing af- 
fection. Dyspepsia is often, if not generally, a consequence 
of habitual debility from the over-exercise of the stomach, and 
it is unreasonable to suppose that the evil can be entirely re- 
moved b}- bodily activity, while the stomach is still subjected 
to the original causes of the disease. Exercise to any great 
extent may even occasion an increase of dyspepsia in certain 
extreme cases, for it tends directly to draw olF from the inter- 
nal organs a portion of the vital force already deficient in the 
stomach, it should therefore be used with caution, and its ef- 
fects should be carefully watched. 

One of the most beautiful effects of exercise as a counter-ir- 
ritant, is witnessed in the systematic management of many af- 
fections of the mind, which, though often distressing, do not 
surpass the bounds of health; but its proper application to such 
complaints receives very little consideration, even from phy- 
sicians. The over-exertion of any set of mental faculties pro- 
duces in the part of the brain in which the organs of these fa- 
culties are seated a condition parallel to that of the stomach in 
dyspepsia, and one curable according to the same laws.* 

Men of literary professions are constantly liable to the ill 
effects of such partial exertions of mind: and dissipated men 
are subject to even more serious dangers from the undue cul- 
tivation of the instinctive feelings. In the former, the mind 
is directly threatened, and in the latter, the bodily powers are 
overthrown by nervous derangements which frequently pro- 
duce the most terrible s;loom and distress, followed sometimes 
by convulsions and a gradual loss of intellect. 

There arc two modes of exercise by which counter-irrita- 
tion may be produced in a manner highly serviceable in these 
local affections of the interior of the brain and cerebellum. 
First; — by employing other portions of the brain while those 
which are over-exerted are allowed to remain at rest, we di- 

* Here, as in several other places, we use the language of the phrenolc 
because, whatever may be thought of their doctrine, it is now universally g 
"ed that their terminology conveys the clearest 

observed by students of the physical operations of the human mind. 



REMARKS ON HYGIENE. 211 

Vert the vital forces from the diseased to healthy organs. 
Thus, the study of natural history constitutes one of the best 
remedies for threatened insanity or deep gloom in poets and 
metaphysicians: that of mathematics alleviates the distress re- 
sulting from wounded feelings or illicit indulgences. Se- 
condly; — by exercising all the muscles we expend a large 
portion of the nervous energy, and thus temporarily diminish 
the functional action of the whole brain, while we more per- 
manently enlarge one of the principal systems of the organs, 
and restore the balance of nature by calling forces from the 
head toward the extremities. We have seen hereditary insa- 
nity held in check for many years by such measures, rightly 
directed; and we have repeatedly cured the established habits 
growing out of the tyranny of the most engrossing passions 
by the same process. Exercise, then, not only improves 
health, in the common acceptation of the word, but the feel- 
ings and the morals also, a healthy condition of which is abso- 
lutely essential to the comfort of the individual. To neglect 
the physical means of cultivating the moral relations of life is 
to outrage the rights of society; and consequently, a neglect 
of systematic exercise may become an offence against religious 
duty! We commend this subject to the reflections of those 
who are the appointed guardians of public virtue. 

It is unnecessary to enlarge upon the subject of exercise in 
other organs and systems, for the same principles which arc 
applicable in the case of the muscles are equally so in that of 
any other organ, whether its function be mental or mechani- 
cal. 

Entire rest of any part allows its power to be lost for want 
of use; regular employment strengthens it and renders it larger; 
too great exercise may occasion undue development, and sub- 
ject the part to disease. Still greater degrees of exertion pro- 
duce, first, irritation, then debility, then a temporary or total 
destruction of power. The exercise of one set of organs calls off 
excitement from all others, and too great development of one 
set occasions a dangerous destruction of the balance of the sys- 
tem. After having carefully perused the remarks contained 
in the chapter on Physiology, these hygienic laws will be en- 
tirely intelligible to the reader. We can but indicate them 
here, leaving their application to himself. 

The title of passive exercises has been given to those recrea- 
tions in which the body is agitated by any foreign force, inde- 
pendent of any exertion on the part of the individual. Of this 
class, we may enumerate, in the order of their activity, swing- 
ing, the see-saw, sailing, carriage-riding, riding on horseback, 
and jolting in wagons. The slight influence of these exercises 



212 REMARKS ON HYGIENE. 

upon the muscular system being thrown out of the question, 
their results depend mainly upon their influence on the circu- 
lation. And this is one of the most beautiful mechanical prob- 
lems involved in physiological reasonings. 

Whenever the body ascends, the fluids in the blood-vessels 
.at first attempt to lag behind because of their inertia, and the 
veins and capillaries of the lower portions of the body are con- 
sequently distended, until the whole mass of fluids acquires the 
general movement. Then, the moment the upward motion 
ceases and the body begins to descend, the circulation becomes 
more rapid by the contraction of the elastic vessels, relieved 
as they are at once from the inertia of the blood contained 
within them. Descending with the body until it reaches its 
lowest depression, the blood continues to flow toward the 
heart, not only by the natural force of the circulation during 
rest, but by the continued elastic contraction of the distended 
vessels; but, at the same time, it acquires its share of the ge- 
neral descending movement of the whole body; and when the 
latter begins suddenly to ascend again, the blood still endea- 
vours to fall, until it is checked with a jerk by the coats of 
the distended vessels, and the reaction of these not only occa- 
sions a full and complete dilatation of the last ramification of the 
capillaries, but produces a sudden jet toward the heart, fol- 
lowed by a rapid current in the same direction. The heart, 
thus filled with more facility than under ordinary circum- 
stances, contracts more speedily, and the pulse becomes quick- 
ened. If the passive exercise be carried too far, palpitation may 
be produced; and if any particular part be excessively weak- 
ened — or if any one organ be affected with irritation," inflam- 
mation, or their consequences — this quickened circulation, so 
general in its influence upon the whole system, may conside- 
rably increase the danger of local disease, and must b 
verned with prudence and caution in cases of patients debili- 
tated by long-continued illness. But with this circumspec- 
tion, how incalculably beneficial are the results of passive ex- 
ercises during long and tedious convalescence! How vastlv 
do they reduce the dangers of relapse, or that utter destruction 
of theenergies of the system which so frequently supervenes 
•upon it! Even in health, these amusements give energy to 
all the animal powers, and fortify us against the encroachments 
of disease. They should be encouraged by all, but especially 
by children. They are the proper exercises of the circulation. 
The results of a sea-voyage, and of many childish sports, both 
upon the health and temper, are at once explained on the prin- 
ciples just laid down. 

.Under the head of deformities, and that of women within 



REMARKS ON HYGIENE. 213 

the month, will be found some precautions with regard to ex- 
ercise under peculiar circumstances — and with these remarks 
we submit the subject to the good sense of the reader. 



ON THE FOOD AND EXERCISE OF CHILDREN. 

Very few persons are aware of the thousand ills to which 
we are subjected, during life, by the misplaced kindness of pa- 
rents, or the carelessness or inhumanity of those who should 
be the guardians of our infancy. 

The mismanagement of food alone, in childhood, lays the 
foundation of long-continued sufferings, or seriously diminishes 
the comforts of a large portion of the human family, and we 
should be guilty of great neglect if we were to pass this sub- 
ject unnoticed; especially as it is one upon which the princi- 
ples of physiology, applied by the aid of a little common sense, 
are capable of shedding the clearest light. 

Milk is designed by nature for the nourishment of the 
young of all the more perfect animals during the first stage of 
their independent existence. Now it is well known to every 
housewife, that the internal membrane of the stomach of an 
animal, even when dried and made into rennet, will convert 
milk from a fluid into a solid substance, which, when allowed 
to remain for a considerable time undisturbed, becomes more 
and more tenacious by contracting, like the coagulum of blood, 
and forces out its more fluid particles in the form of whey, 
while the remainder becomes more and more analogous to 
cheese. This last substance, when fully formed, is well known 
to be peculiarly difficult of digestion, and can only be tolerated 
by the human stomach after having undergone thorough mas- 
tication. The fate of one whose stomach should be complete- 
ly filled with a solid mass of cheese might be easily foretold. 
It would be inevitable death from the same cause which is 
known to destroy life when large quantities of fluid blood are 
taken into the stomach and allowed to coagulate there. Yet 
this coagulation actually takes place whenever milk enters the 
stomach of a living animal, and the same tendency to form a 
mass of cheese immediately displays itself. If the quantity 
taken were large, and it were possible for the function of di- 
gestion to lie dormant for forty-eight hours, under such cir- 
cumstances, there would be serious danger of death from the 
inability of the stomach to act effectively upon the tough sub- 
stance within it. Fortunately, nature has secured to this most 
important organ of organic life, the power of acting immediate- 
ly, and for a long time consecutively, upon any digestible ma- 



214 REMARKS ON HYGIENE. 

terial; yet here, as in every other part of the system, alter- 
nation of rest and exercise are indispensably necessary. 

We find that the free use of milk unmixed with other edi- 
ble matter, can be tolerated by very few adults, except those 
who lead a laborious life in the free air, and whose stomachs 
are thereby endowed with enormous powers of digestion.* 
The reason of this must now be obvious to the reader. Though 
not absolutely indigestible, milk is exceedingly difficult of di- 
gestion in a grown animal; it remains a long time upon the 
stomach, the centre of the coagulum continually growing 
firmer and firmer until, toward the conclusion of its solution, 
it resists most pertinaciously, and the stomach becomes ex- 
hausted, and often permanently weakened by the effort to di- 
gest it. 

But, it will be asked, how then can milk furnish the only 
proper diet, and the most healthful nutriment of early child- 
hood? Plainly for three good reasons. The stomach of an infant 
possesses much less coagulating power, and the central por- 
tions of the quantity taken remain much longer in a fluid con- 
dition than they do in grown persons. In proof of this, it i< 
only necessary to state the fact, that infants often discharge 
fluid milk from the stomach hours after it has been taken, but 
adults, when affected with vomiting, expel it perfectly coagu- 
lated, even in a few minutes after drinking it. The idull 
nerally takes a considerable quantity at a draught, and forms 
one great coagulum at once; the infant, on the contrary, im- 
bibes it slowly, and produces partial coagulation of small de- 
tached portions which are much more manageable. Nature 
even corrects the errors of appetite in the infant, for if an un- 
due quantity of milk be taken suddenly, as is often the case 
when the bottle is employed, the child" soon afterwards ejects 
the surplus in a fluid state, and relieves the stomach of the in- 
jurious load. The occurrence of this species of vomiting is 
justly regarded by nurses as a sign of health; it is seen 
frequently in those infants whose stomachs are in the most 
vigorous condition, but, I believe, never occurs in the adult. 
Lastly; digestion, like all the other organic functions, is car- 
ried on much more rapidly in infancy "than in adult age, and 

* As milk furnishes an admirable diet, when properly managed, in some few 
cases of dyspepsia, and in many pulmonary affections," it mav be well to men- 
tion in ibis place a very singular fact. If to a quantity of milk we 
small quantity of farinaceous mutter, (say a tea-spoonful of flour to the gallon 
of milk,) and if the mixture be then heated to the boiling point and again suf- 
fered to cool, it will be found deprived of those propertied which render it nox- 
ious to the adult stomach. It may then be taken freelv by those who dare not 
partake Of milk in its natural state. The whey, when 
be a healthful beverage at all ages. 



REMARKS ON HYGIENE. 215 

the coagula, or rather flocculi, in the stomachs of the former 
are finally removed long before they have had time to contract 
sufficient firmness to offer resistance to the natural actions of 
the organ. 

The change in the functions and powers of the stomach, as 
the infant advances in age. is gradual, and a corresponding 
change is effected in its natural nutriment. The mother's 
milk, during the first few months, possesses very different pro- 
perties from those which it assumes toward the end of the year, 
being, at first, much less perfectly coagulable, and containing 
a much larger proportion of whey. Hence, one of the chief rea- 
sons of the comparative superiority of development displayed 
by children raised by the mother over those who depend upon 
a wet-nurse, the latter class of assistants being generally chosen 
from among those who have lost their own children, or have 
been compelled to relinquish the care of them after several 
months from the period of birth. Hence, also, the still greater 
evils resulting from the use of the bottle in rearing young chil- 
dren; — the milk of the cow being much less perfectly adapted 
to the wants of the infantile stomach at any period, than is that 
of the human breast. 

Between those periods in which milk, as an article of diet, 
is to be considered healthful in the one and injurious in the 
other, there is a time at which a change in the habits of the 
infant becomes necessary to the preservation of its health, and 
the neglect of this important moment is a fertile source of 
early death or permanently debilitated constitution. This re- 
mark brings us to the subject of weaning. 

Weaning should take place about that epoch in the life of 
the infant at which the stomach has become so far changed in 
function that it begins to coagulate milk speedily and com- 
pletely, and when the masticatory apparatus is sufficiently 
complete to fit it for acting upon solid food. This period, no 
doubt, varies greatly with the temperature of the climate and 
local position. Among the Samoedes and other extreme north- 
ern tribes who, from motives of pure charity, inter the infant 
with the dead mother that they may not see it perish by star- 
vation, the development of the human body is long protract- 
ed. The women are said to be rarely marriageable before they 
reach the age of twenty-five years, and it is reasonable to con- 
clude that the earlier progress of the infantile functions is in 
like manner retarded; hence the practice of suckling children 
for several years, which prevails from necessity in those in- 
hospitable climes bordering upon polar regions, may there bo 
found consistent with the health of these unhappy people. 

Far different is the state of things within the tropics. There, 
women are often marriageable at 10, 11, or 12 years of age. 



21G REMARKS ON HYGIENE. 

and the physical and mental development of the infant is pro- 
portionally rapid; consequently, the proper time for weaning 
is considerably earlier than in temperate countries. The 
United States comprise a vast range of climate, and the law 
which would prove correct in Maine could not be safely fol- 
lowed in Mississippi. 

It is both impossible and unnecessary to designate any pre- 
cise period at which the weaning of an infant is imperatively de- 
manded, but it is easy to establish extreme limits beyond which 
it is highly imprudent to transgress. In the middle states these 
limits may be placed at 9 and 15 months from birth. If cir- 
cumstances oblige us to remove the child from the breast at at* 
earlier moment, the consequences are always troublesome and 
often serious; and if the mother continue to nourish the child 
beyond the latter period, the effect upon the stomach is al- 
ways injurious, though the consequences, in' such cases, are 
very rarely attributed to the real cause. The false tenderness 
which induces some parents to neglect the weaning of chil- 
dren until eighteen months or two years, is altogether inex- 
cusable, and the intelligent physician must condemn, even 
while he pities the motives which occasion similar practices 
to a much greater extent among the poorer class of society. 
There exists, however, one prevalent opinion which demands 
farther notice. It is generally thought that the dangers of the 
second summer are much enhanced* by premature weaning, 
and that sickness or general debility of the infant interdicts 
the attempt to change so entirely its natural habits. "I can- 
not wean my child, noio" says some affectionate mother of a 
child twelve or fourteen months old in May. u It is so feeble, 
and it has to go through its second summer! If it were to die, 
I should never forgive myself! Oh dear! — Doctor, I cannot 
take from it its natural food I" Now, as it is acknowledged 
to be improper to wean in very warm weather, because the 
extreme excitability of the young fibres at such times renders 
the slightest irregularity dangerous, the unfortunate infant to 
whom allusion has just been made, is condemned to the breast 
until the succeeding October at least; that is, until it reaches 
the age of seventeen or nineteen months. In this case, the 
anxious mother is correct in her principles, but she strap _ 
misapplies them in practice. The milk which constituted the 
"natural food" of the child, when under the year, becomes 
unnatural food when it passes that epoch, and the feeble in- 
fant, compelled to combat all the ills of the second summer 
with but slender powers of resistance, is forced, by mistaken 
kindness, to admit daily into its stomach quantities of a fluid 
which becomes daily more and more difficult of digestion \ 
The consequences of this mistake are in a high degree serious, 



REMARKS ON HYGIENE. 217 

and there can be little doubt that the proverbial mortality of 
childhood is much increased by it. In our climate the age of 
twelve months is, as a general rule, the best period for wean- 
ing. If a child be eleven months old at the end of the month 
of May, it should be deprived of the breast about that time, 
rather than that it should be subjected to the evils resulting 
from the continuance of its previous habits to the age of six- 
teen months, when the weather would again become favoura- 
ble to the undertaking. But if only nine months old, or less, 
at that time, it is better to delay the weaning until the suc- 
ceeding October. 

Though the proper period for weaning varies in different 
countries, nature has furnished us, in the dentition of the in- 
fant, with an unerring guide not only in chosing the moment 
for this operation, but also in regulating the after habits of the 
child as it increases in size and strength; and it is a matter of 
astonishment that this circumstance should be so seldom 
touched upon by hygienic writers. Every reader is doubt- 
less aware that the human jaw is provided with three dis- 
tinct groups of teeth for the purpose of masticating the different 
kinds of food employed by omnivorous animals, but it may not 
be so generally known that naturalists are able to determine 
the kind of food requisite for any quadruped by the simple ex^ 
animation of the teeth, without previous knowledge of its ha- 
bits. Now, it is not only true that nature provides nothing in 
vain, but it is equally indisputable that she provides nothing 
out of its proper time and place, so long as her efforts are un- 
influenced by accident or indiscretion. The few quadrupeds 
which, like the infant, are unprovided with teeth, are not de- 
signed to subsist upon solid food, or at least upon that which 
requires mastication; and the whole analogy of nature bears 
us out in deciding that until the teeth are grown no solid food 
should be taken by the infant. The date of the appearance of 
the temporary teeth varies regularly with the climate, and ir-r 
regularly from accidental circumstances; the latter varieties 
may be considered as errors of development, and in those whq 
present them the rules of diet derived from the condition of 
the teeth cannot be strictly applied. 

The incisors of the lower jaw generally make their appear- 
ance about the sixth or seventh month. Those of the upper 
jaw appear soon afterwards. They acquire about the tenth or 
twelth month sufficient size to be decidedly useful, and nature 
certainly never designed that they should remain unemployed. 
The occasional employment of cow's milk, somewhat diluted 
and sweetened, and mixed with such farinaceous solids as are 
easily divided by the incisors, now becomes proper as a pre- 

28 



218 REMARKS ON HYGIENE. 

paration for weaning. The use of bread, mashed potatoes, 
and other vegetable food, should be gradually introduced. 

,The next teeth which make their appearance in the usual 
order are two of the small grinders, a kind of teeth peculiar 
to those animals which subsist upon vegetables, and fitted for 
grinding many of the more solid articles which the incisors 
can only divide. Some few weeks after these, the canine or 
eye teeth, as they are commonly called, make their appear- 
ance, and are soon followed by another pair of grinders. 

The canine teeth are peculiar to animals which subsist on 
meats;, they are designed for .tearing, and their complete de- 
velopment marks the time when it is proper for the child to 
commence the use of solid animal food. In our climate, this 
takes place about the end of the second year; for although the 
canine teeth appear much earlier, they do not reach their full 
size and strength for several months. 

This great change in the habits of the infant should not be 
made suddenly, but with considerable caution, particularly if 
the constitution be weak. 

The use of spices, wine, and all kinds of stimulants should 
be rigorously interdicted until after the child has reached ma- 
ture age, even by those parents who are unwilling to practise 
the precepts given in the earlier part of this chapter. The 
cruel and abominable practice of inundating the delicate and 
highly susceptible stomachs of infants with such stimulants as 
wine, whisky, and beer — a practice far more common among 
the poor, and in agricultural districts, than would be generally 
credited, — should be suppressed by penal enactments. When 
followed in ignorance, it is a mark of stupidity, — when re- 
sorted to by the intelligent, it proves the utter want of prin- 
ciple. I will not abuse the ear of good sense in proof of the 
justness of these violent expressions! 

There are two errors of diet almost universal among chil- 
dren, which demand notice in this place. First; the abuse of 
cakes and doughy articles; and secondly, the use of undue 
quantities of drink. 

Cakes which crackle under the teeth, and which, therefore, 
admit of complete mastication, if made of good materials, and 
not over-burdened with sugar, molasses, or injurious chemical 
substances, may be used in moderation with propriety. But 
how is it to be expected that the stomach can tolerate with 
impunity the constant stuffing of pasty masses of soft ginger 
or queen-cake, pie-crust, and buckwheat dough with which 
mothers, grand-mothers, and aunts continually oppress their 
little favourites, until they are weighed down bv their false 
kindness? These substances — often rendered absolutely poi- 



REMARKS ON HYGIENE. 219 

sonous by the employment of bad flour and chemical correc- 
tives — act in the same manner with coagula of milk and blood, 
and it is unnecessary to dilate upon the consequences; they 
have been already pointed out under the head of weaning. 
The robust, who use much exercise, may not suffer obviously 
from such diet, but it is not only injurious, but no doubt fatal 
in many cases, among those of feeble health or sedentary ha- 
bits. In those who are subjected to the modern system of 
long sessions at school, the intellect itself seriously suffers by 
such habits in eating, and the blame attached to the preceptor 
for the deficient progress of the student, is often chargeable 
upon the parents who continually labour to vitiate the proper- 
ties of the soil designed for cultivation. 

The immoderate use of d rinks (even that of plain water) 
to which children are very much inclined, is a serious injury 
to the stomach, and may be considered one of the most fre- 
quent causes of the dyspepsia which appears later in life. The 
evil results from the distention produced by the fluid. When 
a much larger quantity is taken than the wants of the system 
demand, a considerable portion is apt to remain for hours un- 
absolved, and the constant repetition of this state of things 
soon destroys the tone of the stomach., and prevents it from 
contracting completely and firmly when empty. The blood- 
vessels are then relieved from the natural pressure which they 
should occasionally suffer; they become permanently enlarged 
and relaxed, and incapable of executing their functions with 
promptitude. In this condition of the stomach, after a hearty 
draft of water, the regurgitation of the fluid in the relaxed ca- 
vity may be distinctly heard on any sudden motion of the 
body. The evils following the habit of diet of which we have 
just spoken, are difficult to cure; but the best mode of treat- 
ment consists in the free use of table-salt, which powerfully 
constringes the stomach, and is not unfrequently very service- 
able in the simplest forms of d} T spepsia. 

In childhood, food is required more frequently than in later 
life; and the attempt to confine a boy of less than eight years, 
rigorously to three meals a day, is exceedingly injurious. 
Children should eat often and a little at a time; nor should 
they ever commence the labours or amusements of the day 
without taking something, even though it be but a biscuit or 
a crust of bread. 

On the subject of exercise, sleep, and clothing in children, 
we need not enlarge, for the principles which should govern 
in these matters have been already stated. But we cannot too 
strongly condemn the employment of a few popular adages, 
the practical application of which goes far to render the com- 
mencement of life miserable, to thwart the ends of existence, 



220 REMARKS ON HYGIENE. 

and in some instances to vitiate the moral tone. Parents may 
smile, but 

"These little things are great to little men." 

11 Hold up your head and look like a gentleman." How 
often are poor little creatures condemned to suffer through 
long hours of restraint, in the vain endeavour to cheat the 
world by seeming what, the Creator never designed them to 
be, — arresting the development of their muscles and laying 
the foundation for debility and disease! The phrase should 
unquestionably read, — Toss up your heels and behave like a 
child! 

u Little children were made to be seen, and not heard!" 
What thinking individual is ignorant that childhood is the 
season for the acquisition of facts, which, to be valuable, must 
be explained by their seniors, and that the reception of false 
impressions then, is ruinous to the good government of after- 
life? What an admirable opportunity for the formation of a 
correct moral Code, is enjoyed by the child of six or seven 
years, when seated by the fireside or in a corner of the room, 
during a political discussion over the dining-table, — compelled 
to sit still and reflect without inquiry, while the conversation 
is rendered perfectly free by the assertion of the host, — "Oh! 
never mind him! He's too young to understand!" Reason 
declares that " Little children were made to be noisy and ask 
questions" and religion demands that they should be grati- 
fied! 



ERRORS OF FEMALE SCHOOL DISCIPLIN 

Great evils result to the fairer portion of creation from cer- 
tain infringements upon the laws of Hygiene during the later 
periods of adolescence, — infringements unfortunately most fre*- 
quent among those who most strongly insist upon what they 
consider to be the refinement of female education. These er- 
rors are observed too often in the domestic circle, but as they 
occur much more generally in schools, we have preferred to 
mention them under this caption. 

So much has been already said of the causes of deformity 
from inactivity of the muscles of the back, that it is unneces- 
sary to allude any farther to the ill effects of corseting, par- 
ticularly before the full development of the figure; but it is 
proper to mention that unless the use of seats with comforta- 
ble backs be substituted for the present absurd benches em- 
ployed in schools, a loose corset may prove of great service 
in preventing the exhaustion resulting from continued exer- 



REMARKS ON HYGIENE. 221 

tion in the vain attempt to preserve an upright attitude for 
hours together, by furnishing an occasional support to the per- 
son when it yields to the necessity of rest; but a light corset 
is ruinous, because, by giving a permanent mechanical sup- 
port, it destroys all chance of the necessary occasional exer- 
cise. Certainly it is desirable that the attitudes of students 
should be as easy as possible while the mind is closely en- 
gaged, and common chairs in confusion would be infinitely 
better calculated for school service than the stitF, orderly 
benches now in general use. But it seems to be adopted as 
an axiom in our system of education, that physical uncomfor*- 
tableness is a strong incitive to the mental efforts of children! 
The parents of Lady Jane Grey pinched her and twisted her 
ears while studying, to fit her for a throne! The system 
brought the lovely sufferer to a scaffold! Just so, we have 
seen the modern student tormented, to fit him for distinction 
by means, which, in the strife and struggle of after life, have 
landed him in an alms-house! 

The long sessions now so general in schools, ought to be 
decidedly condemned; and in cities, where ample play-grounds 
cannot be provided for females, a separate room for the ruder 
amusements should always be provided within the building. 
No session should be extended beyond one hour and a half, 
without an interlude of half an hour; and in exercises on that 
most trying of seats — the music stool — the lessons should be 
much shorter, and the intervals much longer. Calisthenic ex- 
ercises (female gymnastics) should be universally encouraged, 
and among the most important of the games tending to cor- 
rect the vices of form and habit resulting from school disci- 
pline, we would expressly recommend battledore, and jump- 
ing the rope. For farther practical hints on this subject, see 
the article spine in the second part of this work. 

The next subject of importance, which claims our attention, 
is the necessary protection against cold and exposure to damp 
in school girls who are approaching the most critical period 
of adolescence. The regulations of seminaries are made for 
the government of the many, and, like all human laws, must 
press unequally upon the few, for laws cannot be rendered 
perfect. The dress of boarding-schools, though somewhat 
more rational than that observed in general society, is still so 
badly regulated in the case of young girls, as to be productive 
of incalculable evil; and, were the task not absolutely hope- 
less, we should feel inclined to decry the use of thin shoes 
and stockings; but there are other still more important expo- 
sures which must not be passed unnoticed. The fatal opinion 
-that children are hardened by exposure, is very popular among 
the principals of female schools, who, being generally men, 



222 REMARKS ON HYGIENE. 

and therefore ignorant of the peculiar precautions necessary 
for the protection of those of the other sex, neglect such mat- 
ters in the construction of rules of government. Their lite- 
rary assistants are commonly unmarried females, often not 
much advanced in age; and it is not to be expected — both on 
this ground, and, also, because the relative position imposes 
restraint, or endangers the destruction of discipline — that these 
teachers can be confided in by the pupils, as their confidential 
advisers on subjects of peculiar delicacy. 

The housekeeper is, too frequently, eitber the wife of the 
principal or some one chosen from the ruder walks of life, and 
unacquainted with, or forgetful of the wants of the refined, the 
delicate, or the young. If the wife — her near connexion with 
the head of the establishment causes it to be frequently 
esteemed dangerous to trust her, lest punishment or loss of 
confidence should follow the acknowledgment of trilling in- 
discretions; and thus distrust and concealment too generally 
become habitual among the students. If, on the contrary, a 
housekeeper be a woman of little education or moderate in- 
tellect, she can neither win upon nor understand the feelings 
of those who are of a more refined class than herself, nor can 
she become the adviser of those who commonly exceed her 
in knowledge, and not unfrequently io e.rj)erience also, if we 
apply that much abused word to observation coupled with re- 
flection. There is, then, a necessity for some one, in every 
well conducted female boarding-school, who should stand in 
the relation of a mother and intelligent nurse to the children, 
not only in sickness, but in health. She should be the inti- 
mate of their hours of amusement; she should be freed from 
the duty of ever imposing tasks upon them. Her control 
should be absolute over the wardrobe and the toilet; and her 
authority paramount to the established regulations of the 
school on all exceptionable cases of diet and regimen. Her veto 
should even annul the edicts of the master in cases where she 
thinks rewards or punishments incompatible with health; but 
she should have no power, herself, to punish or reward, or her 
feelings would inevitably overthrow her usefulness. 

To such a character, and to parents in general, we would 
•suggest the following hints. 

A girl approaching to her period of full development, or 
one who has passed that period, should never be permitted to 
expose herself to cold at critical times. We will name but 
two of the applications of this rule, the neglect of each of 
which has proved the ruin of the health of many, and the death 
of some lovely beings under our own immediate cognizance. 
It is customary, at most boarding-schools, for the children in- 
discriminately to wash in the morning in open sheds, or in 



REMARKS ON HYGIENE. 223 

bleak pump-houses, which are intensely cold in winter, and 
perpetually clamp and chilled by evaporation in summer. There 
are particular moments when this exposure is extremely dan- 
gerous to females, and it is exceedingly improper to intrust 
the observance of the requisite caution on these occasions to 
the judgment of children or the foresight of young or igno- 
rant assistants. Moreover, there are, in every school, some 
individuals of delicate constitution to whom such exposures 
are, at all times, highly injurious. 

Humanity requires that the rigid rules necessary for gene- 
ral government should give way under such circumstances, 
and the occasional appearance of partiality in yielding peculiar 
privileges to the few, is no valid plea for avoiding the proper 
arrangement at the expense of personal cruelty. 

Among the modes of punishment not unfrequently adopted 
at schools, is confinement to a seat in a cold room or gallery 
during a stated time, in the intervals between the sessions. 
Whether this outrageous abuse of power is ever practised in 
seminaries for females we know not; but having suffered se- 
verely ourselves, and having witnessed much suffering, and 
one death from this punishment in a boarding-school for boys, 
— of high character, and governed by men undoubtedly con- 
scientious and esteemed intelligent, — we deem a caution on 
this subject necessary, not knowing to what extent the inde- 
fensible custom may prevail. 

Another more popular mode of domestic or scholastic pu- 
nishment consists in confining the offender in a room, either 
depriving her of a meal, or restricting her to bread and water, 
according to the supposed enormity of the offence committed. 
Solitary reflection and compulsory idleness are the worst of in- 
flictions upon a child, consistent with physical health, and, 
rightly managed, furnish the best means of taming the un- 
governed will — but the irregularity of meals, and the depri- 
vation of nutritious diet, rapidly destroys the tone of the sto- 
mach at any age, and are by far most injurious in childhood. 
The consequences are the more to be dreaded, because they 
seldom attract attention until the cause is forgotten. 

The absurdities practised in seminaries, with regard to diet, 
are so numerous that we cannot pretend even to attempt a ca- 
talogue of them, but it is hoped that the remarks contained in 
a previous section will attract attention to the subject, and 
lead to the removal of much of the evil, the existence of 
which can only be attributed to the want of any attempt to 
regulate such matters by the plain laws of common sense. 
We cannot avoid, however, a notice of two ludicrous cases in 
point drawn from the vivid recollections of boyhood. 



224 REMARKS ON HYGIENE. 

Suddenly removed from a course of sedentary study in a 
capital city, with a constitution somewhat enfeebled by the 
want of powerful exercise, free air, and sunshine; but robust 
and rather remarkable for muscular development among city 
children, — w r e were placed, at the age of ten years, within the 
halls of one of the most carefully regulated boarding-schools 
in the country. Our appetite was keen, for we had ridden 
many miles — our dinner was plain, but good — and we did to- 
lerable justice to the soup and meat, but for the dessert, we re- 
ceived, like all our companions, great aud small, older or 
younger, an enormous segment of a most enormous pie! say 
six inches for I he cord of the arc, and ten or twelve for the 
radius, geometrically speaking. Our lusty associates caused 
their several portions to disappear with alarming rapidity, — 
and by the time we had nibbled off some six inches of the 
acute angled extremity of our own — the meal was ended!! — 
We rose to depart, but one of the scholars whose turn it was 
to act as a kind of steward to our form, arrested us with the 
information that it was held a breach of decorum to leave any 
thing remaining on the plate ; and that it was therefore neces- 
sary that the pie should be demolished! Horror-struck, we ex- 
claimed that the feat was utterly impossible, and an appeal 
was made to the preceptor at the head of the table. But the 
law was imperative; and after a few tears and some no very 
agreeable thoughts of home, we made our charge most man- 
fully. Again, and again, the absolute nausea of repletion 
checked our progress; but there stood the vicegerent, (the pa- 
tience of the teacher being exhausted,) whose only answer to 
all expostulation was "You must eat it! — Master Amos says 
so!" Never shall we forget the sufferings of that terrible din- 
ner! But there is an end to all things. After three hours 
of strenuous exertion the monstrous load disappeared, the lat- 
ter portions literally moistened with our tears. Fortunately, 
the pastry was vilely simple in composition, or we had not 
lived to tell the agonies of home-sickr.ess and heart-broken 
misery endured, when, after losing an entire afternoon session 
in the school-room, we e-caped from the dining-room to the 
play-grounds and seated ourselves, with aching masticatory 
apparatus, and unbuttoned jacket to witness the gambols in 
which we could not share! Supper we could not dream of — 
though, as it was a rule of the school that all who were not on 
the sick-list should be present at the table, and though this 
rule was authoritatively announced by the preceptor, our bit- 
ter tears, and the plea of our recent arrival at last obtained for 
us a dispensation. Next morning we made a confidant of an 
older scholar, and consulted him as to the means of evading 



REMARKS ON HYGIENE. 225 

such horrible inflictions in future. " Nothing easier," he re- 
plied, " when you've got more than you want, slyly pocket it, 
and when you come up, throw it away!" 

By the aid of this innocent manoeuvre, we were enabled to 
get along in tolerable comfort, until the gradual distention 
of our stomach, and the vigour produced by romping games 
in the free air of the country, enabled us to dismiss one of 
those fearful pieces of pie with great satisfaction; but at that 
school was laid the foundation of a dyspepsia from which we 
are never likely to recover! 

Another scene at the same school resulted from the attempt 
of the teachers to compel an unfortunate youth to partake of 
the usual nightly fare of mush and milk. He had a peculiar 
idiosyncracy which made it impossible to retain the article 
upon his stomach. His finesse in concealing his absence from 
the supper-table, or in getting his neighbours to relieve him 
of the disagreeable duty of eating that which he loathed, at 
length failed in protecting him. The laws prescribed not only- 
presence at the table, but active co-operation in the demolition 
oi mush and milk! Compulsory process was issued, and the 
unfortunate lad was placed under guard, and allowed nothing 
at his subsequent meals but the identical bowl of this homely 
material at first refused, until cured of his contumacy, which 
was attributed, in spite of his asseverations to the contrary, to 
a fondness for luxury or a contempt for the table. Breakfast and 
dinner passed untasted; but the prisoner had many friends: 
when supper appeared, and the word of attack was given, the 
teachers were astonished at the universal silence which per- 
vaded the dining-hall. 

The children had made common cause with the sufferer, 
and philosophically refused to cat their meal, unless he was sup- 
plied with more palatable food. The dignity of the teachers 
was compromised and the whole school, with one exception, 
went supperless to bed. The hard law which bore upon the 
obstinate individual was not relaxed, and all the rebellious 
were condemned to be deprived of their occasional luxuries 
until they returned to obedience, and mush and milk! On 
the next evening only six generous fellows, undauntedly lost 
their suppers in defence of principle; and these were locked 
up in a room employed as a species of prison for delinquents, 
with their porringers before them to yield or die. Three days 
passed by, yet still the urchins looked as hale and vigorous as 
ever, — the untouched mush and milk had grown dry and 
mouldy! The teachers found themselves in a ridiculous po- 
sition, and were compelled to yield to necessity by permitting 
the cause of all this turmoil his free choice between mush 
and milk, and a supperless night! Long, anxiously, and in 

29 



22G REMARKS ON HYGIENE. 

vain did the preceptors seek the cause of these camelion-like 
powers of their pupils! Twenty-four years have passed since 
we figured in these scenes, and will now venture to hint that 
they were supported hy the ingenious petty larceny of their 
fellow pupils. The modus operandi we forbear to mention, 
in charity to future victims of oppression. 

One of the ornaments of the profession will smile to see this 
little story, in which he was the principal actor; but he will 
coincide with me in the opinion that the dietetic system of 
this extremely well regulated school was not very philosophi- 
cally adapted either to the physical comfort or moral well-be- 
ing of the pupils. 

We will here close our remarks upon school discipline, in 
the hope that our hints may lead not only preceptors but pa- 
rents to reflect upon the real importance of many little details 
relating to education which it is impossible to notice in this 
work. 

OF MATRIM' 

We come now to a very important subject, upon which our 
previous remarks on physiology anil h; should hai 

practical bearing, and it is intended to devote a :• s to 

their application, to an important epoch in the career of the 
fairest portion of the creation, WOM itined 

to be the bosom friend of man, and the medium through which 
the race is to be perpetuated. We ti 

cused by them from any disposition to invade their peculiar 
privileges, if we venture, as their philosophizing frien 
mark out the course proper for them to pursue in order to at- 
tain the great end of their 

Given as a help meet for man, it becomes woman to j 
obedience to those laws which tend to the improvement of 
the race. 

From what has been said in the pi part of this work, 

it will be remembered that the d< :it of the ho 

successive, that one organ after another comes into play. Thus, 
at the very earliest observable period, human c is mere- 

ly vegetative, without volition, sensation, or motion; as the 
muscles become developed motion is effect 
system is expanded sensation is experienced, and after : 
reached another degree of development volition is man 
After birth, the animal and organic life gradually acquire force, 
till they, in concert with the cerebral mass, become consoli- 
dated, and intellectual manifestations occur. By degrees the 
being expands, the strength increases, anil, as a common rule 
in this country, at about the age of foul -;imcs 



REMARKS ON HYGIENE. 227 

the capacity of reproducing the race. Still, however, this sea- 
son is premature for the health}' performance of this function. 
Early marriages are to be deprecated, as they materially in- 
fluence the health and well-being of the offspring; this is evi- 
dent, not only in mankind but in inferior animals. Let all 
the organs of the system be kept in a healthy condition, — let 
them acquire firmness, with their functions unimpaired by 
improper use, and, under circumstances otherwise favoura- 
ble, we may readily calculate upon the most happy result of 
a judicious marriage — a family of healthy children. 

The exact period at which the body becomes fully expand- 
ed is not readily fixed, being much influenced by the original 
constitution, the physical and moral education, as well as the 
climate, habits of life, &e. While in the tropical regions, the sys- 
tem is as it were forced into a rapid development, and females 
not unfrequently become mothers at 9 or 10 years of age, in 
the colder regions women are not prepared for this function till 
at a much more advanced period. The ancient Germans, who 
were remarkable for their bodily and intellectual vigour, were 
very exemplary in their moral habits, and never married till 
they were 24 or 2Z years old. 

All other circumstances being favourable, we might, perhaps, 
consider that from l! le, and 23 to 

2S for the male, would be the proper period for marriage in 
this country. 

It is the result of observatir mtering upon 

the arena of matrimonial duty at the '22 years, 

may become mothers e a family in the course of the 

next fifteen years as those who position at the ear- 

lier age of 14, 1 5 or 1 provided both are placed under 

equally favourable circumstances, while the former will proba- 
bly find them- hausted by tlit change, and enjoy all 
the pleasure of being surrounded by a more vigorous offspring. 

In large cities where free air and sufficient muscular exer- 
cise are not easily obtained, precocious marriages are produc- 
tive of much evil, causing not only diminished vigour, and 
short life in the father, blighted health and tarnished beauty, 
as well as premature decline of life, in the mother, but also 
debility of body, predisposition to diseases, such as scrofula, 
rickets, and consumption, together with imbecility of mind, 
or even fatuity of intellect in the children. In healthy dis- 
tricts of open country, where the calm pursuits of agricultural 
life do not much interfere with the dictates of nature, less 
inconvenience will probably result from a slight anticipation 
of the time we have intimated as commonly the best for ef- 
fecting the new relation. In newly settled countries marriage 
contracts are often determined by the ability of the husband 



228 REMARKS ON HYGIENE. 

to purchase a small tract of land, in the labour of clearing 
which his young wife will often aid, till called therefrom by 
the imperious duty of fostering her offspring, which in the 
course of a very lew years often become numerous, and gene- 
rally attain to great vigour of body and mind. 

Those who, in order to escape the fatiguing duties of a ma- 
trimonial life, and continual anxiety from the care of young 
children, resolve not to wed themselves to such a charge, and 
thus aspire to sail lightly along the tide of life, should remem- 
ber that while they fail to fulfil one of the objects of their ex- 
istence they are in general more short-lived than those who, 
having rightly cultivated and exercised their organic functions, 
are sometimes remarkable for their longevity. Hufeland tells 
us that all those who have attained to a great age were mar- 
ried even more than once, and generally at a late period of 
life; and that there is no instance of a bachelor attaining a great 
age. There are some striking instances of advanced life where 
marriage was often repeated. Thomas Parr, of England, who 
lived 152 years, was married several limes; De Longvillc, 
of France, lived 110 years and married 10 wives; the writer 
has seen Andrew Wallace, a Scotchman by birth, though ac- 
tively engaged in the revolution of this country, which lie had 
adopted as his own, moving with pretty firm step, in the 
streets of Philadelphia at the age of 10G. We believe he had 
been married several ti 

Not only is it important in our estimation that the persons 
who become candidates for marriage should have attained a full 
development of their organs, but, in order to the happiest result, 
both parties should be possessed of health and a good consti- 
tution; for it is possible that the organs may be brought up to 
their full development without their having acquired that 
firmness and stability which cannot be easiiy deranged by the 
changes which occur in the progress of the function of repro- 
duction. It is true that we occasionally meet with children 
apparently very robust, though born of feeble parents: these 
exceptions, if properly watched, will be found to fall within 
the rule; for sooner or later we witness in most of them the 
premature decay of the rosy cheeks, marasmus, phthisis, or 
other manifestations of a scrofulous diathesis. If these chil- 
dren should attain to manhood, and in their turn become pa- 
rents, what is to be expected other than a rapid degeneration 
of the race? 

It is well known that the diseases of parents are often visit- 
ed upon the children or the children's children through seve- 
ral succeeding or alternate generations, and unless great care 
is exercised in their moral or physical culture, whole families 
decline from the bodily and mental vigour for which they 



REMARKS ON HYGIENE. 229 

were once remarkable, until they either sink into obscurity 
or become pests to society. This observation will apply to the 
intellectual as well as the physical condition, and as a vicious 
predisposition in either may be developed in afterlife, though 
the early years may have been passed in apparent good health 
both bodily and mental, parents are bound to investigate the 
morbid hereditary tendencies of their offspring before they 
encourage their intermarriage with those who display similar 
tendencies. We may, perhaps, be permitted, owing to the 
importance of this subject, to introduce the strong language of 
Dr. Reid on this matter. "Nothing can be more obvious, 
than that one who is aware of a decided bias in his own per- 
son towards mental derangement, should shun the chance of 
extending and of perpetuating without any assignable limit 
the ravages of so dreadful a calamity. No rites, however 
holy, can, under such circumstances, consecrate the conjugal 
union. In a case like this, marriage itself is a transgression 
of morality. A man who is so situated, in incurring the risk 
of becoming a parent, involves himself in a crime which may 
not improbably project its lengthened shadow, — a shadow, too, 
which widens in proportion as it advances, — over the intellect 
and the happiness of an indefinite succession of beings." It 
becomes our duty, then, to comply with the duty of averting 
or mitigating these evils by judicious and well selected mar- 
riages, and a properly directed physical education. In this 
way we may do much in arresting the transmission of heredi- 
tary bias: and by invigorating the general system we render 
it less susceptible to exciting causes, and strengthen those parts 
which may be liable to diseased action. Experience has taught 
the necessity, in some of the old countries, of avoiding these 
evils as far as possible, and it is said, particularly in Europe, 
that in the higher ranks of society, before the marriage con- 
tract is signed, inquiry is frequently made whether either of 
the parties are liable to any disease by hereditary* descent, the 
gout, however, appears to be excepted; this being a disease to 
which the royal family is incident, or being an evidence of 
the good living of the family, may possibly be considered a 
mark of distinction instead of an evil! Marriages have been 
frequently broken off, even at a late period, when it was dis- 
covered on the side of either party, that scrofula, consumption, 
or madness had existed, or was actually existing in any mem- 
ber of the family. 

The efforts which have been made within a few years past 
to destroy the vice of intoxication, so common in this coun- 
try, have been already commented upon in the early pages of 
this chapter. This practice, as well as general dissipation, 
should be strongly deprecated by females, who should never 



230 REMARKS ON HYGIENE. 

unite themselves to a man addicted to either of these habits; 
and we agree with a late luminous writer on this matter, that 
they shoul I be protected by legal divorce if the husband should 
acquire the former habit after marriage. Constant or frequent 
excitation by intoxicating drinks impairs the intellect; general 
dissipation acts most powerfully in enervating the strength of 
the body; and not only does the woman suffer all the horrors 
which attend such indulgences in her husband, but her off- 
spring too frequently inherit feeble constitutions. 

There is no other form in which the curse falls either so 
commonly or so terribly upon the evil-doer, as when his 
crimes impair the moral or physical sanity of his children. It 
seems cruel to deny to the repentant the solace of domestic 
enjoyment, — often the only means of restoring them perma- 
nently to society and usefulness, — to present and eternal wel- 
fare; but we owe it to our readers, as a duty, "to stale that it 
is not by example alone that the son of a drunkard is so often 
led to resort to intoxicating drinks, and that the child of the 
libertine flics to the haunts of vice, or dies prematurely in 
his innocence from the results of bodily inherited with 

his paternity! Inherited, did I say? Too often the victim falls 
before the parent, who, perhaps, has lot Hen the suf- 

ferings entailed upon him- youthful indiscretions" 

and dreams not that lie winged ihe arrow that leaves him de- 
solate ! Habits, like i . are of; litary! The 
stronger sex pursue, with unrelenting cruelty, the slig 
errors of the weaker. By w! an of 
the world attempt to oppo :i justice 
to take her course, we utter a .lion to those fair 
beings whose rights are so feebly protected, even in the most 
civilized societies ! lie may be amiable and good-heartt 
the common opinion of mankind. Even aft ling upon 
the crushed hearts of others whose wcalv is pro- 
tection, he may be held magnanimous and noble. Perfect 
may he be as Crickto .. mtiful even as Antinous. 

Yet beware! If you would not resemble the pale statue of 
immortal Grief in her vain strife to shield the last sad relic 
of her lovely ones — the childless mother circled by her dead ! 
Then shun that most mistaken thought, so often uttered by 
the fondest of your sex and the worst of ours, " The re- 
formed rake is the best of husbands."' 

While we have thus furnished to the female some points of 
importance to her in placing herself in a position to perform 
the part she is to act in life, we must not pass over, without 
proper notice, the qualifications necessary for her to possess, be- 
fore she should enter upon this interesting and important sphere 
of duty. In proportion to the value she sets upon her own 



REMARKS ON HYGIENE. 231 

health, and the gratification she would feel in finding herself, 
at a proper period of life, surrounded by a group of healthy 
children whose physical and mental powers she would be the 
happy agent in expanding, let her not pass over lightly, or con- 
ceal any physical disability which might make marriage fatal to 
herself, or give evidence that by such concealment she had 
been dishonest to the man who entered into this relation with 
her. The existence of cancerous affections, or a known predis- 
position to them, should always be considered by her an ob- 
jection to matrimony. There are also certain physical con- 
ditions of her system which render her liable to more than 
ordinary suffering from parturition, if this process take place 
for the first time at a late period of life: and a woman be- 
coming a mother at this time will also be liable to be de- 
prived of the pleasure of seeing her children settled in life 
before she is herself obliged to leave the world, even by the 
common contingencies of age. We would therefore suggest, 
that those who have deferred this ceremony till beyond the 
thirty-fifth year, had better wait till they have passed the 
period of becoming mothers. 

We will now close this subject, and with it the chapter on 
Hygiene, with a single remark upon the means by which he- 
reditary tendencies may be eradicated, or rendered weaker in 
families, by judicious intermarriag 

It is well known that, as a general rule, the offspring par- 
takes of the peculiarities of both the parents. Now heredi- 
tary diseases are, for the most part, the result of either a 
deficient or an undue development of some particular organ 
or system; and by marriage with one whose natural tenden- 
cies are the reverse of our own, we may neutralize the 
diseased disposition of both parents in the constitution of the 
offspring. Thus, a female of lymphatic temperament, who is 
obviously predisposed to cancerous affections, may intermarry 
with a man whose circulatory apparatus is unduly developed, 
and who is threatened with hemorrhagic or apoplectic dis- 
ease. In this case the probability of the occurrence of cancer 
or hemorrhage among the descendants would be much less 
considerable than if the parties had formed a connexion among 
those more closely resembling themselves respectively. An- 
other instance of the same kind of compensation is observed 
when a powerful and athletic individual, whose mind is per- 
haps less vigorous than his person, intermarries with a scrofu- 
lous or consumptive female, whose talents are precocious and 
whose genius preys upon the corporeal energies. Unfortu- 
nately, this mode of correcting idiosyncrasies is not entirely 
effective; for once in a few generations, some individual of the 
race, impressed with the peculiarities of his progenitor, almost 



232 REMARKS ON HYGIENE. 

always appears, and sinks a victim to the demon who haunted 
the parents! Yet, sufficient good results from the considera- 
tion of physiological principles in matrimonial arrangements, 
to render the advice of a medical philosopher highly impor- 
tant on many occasions. 

In our land, where the free play of the heart is more gene- 
rally consulted in love affairs than in any other, it may seem 
almost hopeless to lay down any rules on such a subject; and 
far be it from us to desire to roughen the " way of true love" 
by any unnecessary checks! Nature, were not her dictates 
thwarted by the errors of false education and by ridiculous 
conventional arrangements, would regulate these matters even 
better than the doctor, — for it is a singular fact that attach- 
ments of a serious character are much more frequently formed 
between dissimilar individuals, than between those who 
strongly resemble each other; the strange likeness so often 
observed between husband and wife, when they have been 
long married, being an acquired one from similarity of pur- 
suits and position, and not an original one from primitive 
conformation: — it is physiognomical, from community of feel- 
ing, — not structural, from constitutional identity. 

But even with us the progress of luxury, refinement, folly, 
and vice, is rapidly introducing customs at variance with na- 
ture. Matrimony has become, and will continue a matter of 
over-legislation — and our hints may be useful to those who 
do not consider beauty as paramount to duty, and wealth 
more estimable than health. 



PART II. 



PRACTICAL, DIRECTIONS 



FOR 



THE TREATMENT 



MEDICAL AND SURGICAL CASES. 



30 



PART II, 



CHAPTER I. 

OF SURGICAL ACCIDENTS AND DISEASES. 



In the present chapter it is proposed to speak of the mode 
of treating accidents and external diseases, so far as they can 
be safely managed, when the advice of medical men is not at- 
tainable. 

It has been customary, in most popular treatises on medi- 
cine, to arrange the subjects alphabetically for convenience in 
reference, but the author deems it more proper to preserve 
more strictly the mutual connexions between the various af- 
fections which fall under the notice of the practitioner, because 
facts are always better understood and retained more readily 
in the memory, when viewed in their relation to other facts 
which are similar in character, causes, and results. The sub- 
ject of this chapter will therefore be divided into numerous 
sections, commencing with those injuries which are purely ac- 
cidental, then treating of local inflammations and their conse- 
quences, and concluding with some of those affections com- 
monly ranked with surgical diseases, and usually termed con- 
stitutional and specific. 

SECTION I. 

OF WOUNDS AND CONTUSIONS. 

A contusion or bruize is but an internal wound, or a wound 
which does not communicate with the external air, for al- 






236 OF INCISED WOUNDS. 

though some bruises are not apparently attended with the tear- 
ing or separating of the flesh or other soft parts, the effusion 
of blood from the vessels, which occasions the black and blue 
colour of such parts, proves that many of the capillaries at 
least, are really torn — for this reason we class these two kinds 
of accidents together. 

Of Incised Wounds, or such as are made with a sharp cut- 
ting instrument. 

Wounds of this class are always attended with rapid bleed- 
ing, and if the quantity of flowing blood be considerable, this 
discharge demands immediate attention. The dark red colour 
of the venous blood is generally very easily distinguished from 
the bright scarlet of that which springs from an artery. The 
former always flows in a steady stream, while the latter is 
thrown out by fits and starts; each jet of which, when large ves- 
sels are divided, often flies many feet from the wound and cor- 
responds with one bound of the pulse. When the arteries are 
very small, this jerking motion of the blood is scarcely per- 
ceptible, but in such cases there is rarely much occasion to de- 
termine the character of the vessel. Bleeding from the veins 
is seldom attended with great danger, and is easily stopped by 
pressure on the orifice of the vessel or near the side of the 
wound. The bleeding from veins almost always appears 
chiefly on the side of the wound farthest from the heart, but 
that from arteries, except in wounds about the joints, usually 
springs from the side next the heart. 

Modes of stopping the Bleedijig. If the discharge of blood 
be small in quantity, it generally stops, in a little lime, without 
the assistance of the surgeon; but in all cases, except in wounds 
from glass or china, it is right to cheek it by pressing the edges 
of the wound firmly together and keeping them so by proper 
dressings. If the wound be on the forearm, hand, leg or foot, 
the bleeding is much retarded by placing the limb in the most 
elevated position, (that is, above the body.) and supporting it 
there. If the wound cannot be closed, it is often proper to 
fill it with lint, which, by coagulating the blood, prevents its 
further escape; and if this fail, some lint may be dipped in a 
strong solution of alum, and then stuffed into the wound; 
but this mode of treatment is altogether inadmissible, unless 
the injury be of such a character that the wound cannot be or 
ought not to be healed immediately. There are many more 
powerful remedies for these slight hemorrhages, of which the 
most formidable is the actual cautery, or burning with a hot 
iron; but the attempt to use these without competent surgical 
advice would be extremely improper and dangerous. 

When the amount of bleeding is more considerable it is 
often necessary to take up the arteries, and if their mouths 



ARREST OF THE BLEEDING. 237 

are distinctly seen on separating the edges of the wound, 
they may be safely seized by a pair of small pincers or a de- 
licate hook, and tied lightly with a ligature composed of two 
or three strands of waxed sewing silk, slightly twisted. The 
arteries in such cases are recognised by the jet of blood that 
shoots from them at every pulsation, and care must be taken 
to confine the noose of the ligature as closely as possible to the 
artery alone, for fear of including some of the little branches 
of the nerves which are often found close in the neighbourhood 
of these vessels. This little operation can rarely be attempted 
by those who have no surgical education, but it may be useful, 
wilder certain circumstances, for all to be acquainted with it. 

If the wound be located on either of the extremities, — until 
proper medical assistance can be obtained, it is easy to com- 
mand the hemorrhage by means of a tourniquet, an instrument 
which will be presently described. 

If a very large artery be wounded, such as the principal blood 
vessels of the neck, the arm, or the thigh, it is almost impossible 
for any one unacquainted with surgery to retard, even for a mo- 
ment, the fate of the patient, unless the tourniquet can be em- 
ployed. The bleeding, in such cases, is tremendous, and 
threatens rapid dissolution. 

The Tourniquet is an instrument intended to apply and 
tighten a ligature about a limb, near to the body, in such a 
manner as to compress all the blood vessels of the limb so as 
to arrest completely any hemorrhage which may occur in any 
part of it. This is the instrument employed by operators, to 
prevent bleeding while they amputate a limb. It cannot be 
employed for many hours together without destroying the vi- 
tality of the member, and is, therefore, only a temporary re- 
medy. It must be placed, in all cases, between the wound 
and the limb — and should always be applied on some part of 
the limb which contains but one bone, for in the leg or fore- 
arm the vessels between the bones would continue the circu- 
lation in spite of the tourniquet. Thus, in wounds of the hand 
or forearm, it is usually fixed about the middle of the arm, and 
in those of the leg or foot, on the middle of the thigh. The 
instrument as employed by surgeons, is too costly to be found 
in families, but the field tourniquet, which is a simple strap 
with a peculiar pad and buckle, might be used with propriety 
on large plantations: it is designed for military surgery, and 
is sold by all the instrument makers. The best substitute for 
sudden emergencies is the following. Tie a silk handkerchief, 
folded diagonally, till it is about two inches wide, loosely 
round the limb where the tourniquet is required, so that the 
knot, which must be very secure, may bear as nearly as pos- 
sible over the route of the principal artery of the limb which 



23S OF INCISED WOUNDS. 

is a little in front of the middle of the inner side of the thigh 
or arm. Now take a short stick, (six inches of the end of a 
brush-handle will answer the purpose,) and thrusting it under 
the handkerchief, on the outside of the limb, twist it till the 
bleeding stops. If time permit, it is best to place a flat com- 
press of linen or muslin beneath the stick, to keep the hand- 
kerchief from pinching the skin; and if the operator knows 
exactly the route of the artery, it is also advisable to place a 
small roll of muslin beneath the knot. By a general know- 
ledge of this mode of treatment, the life of many a patient 
may be saved until surgical aid can be procured from a dis- 
tance of twenty miles. No matter how severe the wound 
may be, if the bleeding threatens the life of the patient, the 
tourniquet should be instantly applied by the most intelligent 
by-stander who possesses sufficient nerve for the purpose. 

Wounds beyond the reach of the Tourniquet. When 
wounds of large arteries take place so high on the thigh or 
arm that there is no room for a tourniquet between the wound 
and the hip or shoulder, death generally takes place very ra- 
pidly, unless aid be afforded by an intelligent and prompt 
assistant. The finger placed on the groin near its inner side, 
feels a strong pulse beating just where the main artery of the 
limb passes over the edge of the pubic bone, (see anatomy 
of the pelvis,) and just at this spot, the end of the thumb 
pressed strongly on the bone cuts off the greater part of the 
circulation by closing the artery, and very much lessens, if it 
does not entirely cheek the hemorrhage. The great artery of 
the arm winds round and over the first rib, behind the clavi- 
cle or collar bone, (see skeleton,) and by pressing the thumb 
strongly down behind the latter, its pulse may be felt. Pres- 
sure in this place stops a bleeding from the large arteries of 
the shoulder or arm-pit, but it is an extremely painful mea- 
sure. 

By such means as have been just described, the life of a pa- 
tient may be preserved for half an hour while a surgeon is 
called, and the instruments prepared for a" serious operation. 
But the position of the artery in these two situations should 
be ascertained before the accident, by those who wish to be 
prepared for usefulness on momentous occasions. When the 
wound is bleeding, it is generally too late for the novice to at- 
tempt a successful exploration. The uninitiated operator must 
husband his strength and suppress his feelings! This kind of 
pressure cannot be long preserved without extreme exhaus- 
tion. We have several times had valuable lives suspended 
upon the last joint of our thumb, and ice never perspired more 
freely! 

In wounds in which large arteries are divided on one side 



UNION BY THE FIRST INTENTION. .239 

of the neck, and only on one side, life may be preserved for 
a few minutes, provided there is room enough for pressure 
with the thumb between the clavicle and the lower edge of 
the wound. The carotid artery may be stopped by pressing 
the thumb backwards between the outside of the wind-pipe 
and the front edge of that large muscle which winds round 
the side of the neck from the breast-bone to the long projec- 
tion immediately behind the ear. Along this space the pulse 
of the artery is very plainly felt. When large arteries on 
both sides of the neck are wounded, no one but an accom- 
plished surgeon can be of any use, and even he can rarely 
save the patient; for stopping both carotids at the same time 
would in itself occasion death, by nearly cutting off the circu- 
lation in the brain: the two small cervical arteries, which alone 
could carry blood to the interior of the head under such cir- 
cumstances, are, in all probability, unable to maintain the 
functions of so large and important an organ even for an hour. 
When one carotid, or its principal branches are cut, life can- 
not be preserved many minutes without a surgical operation, 
for the connexions between the vessels on the two sides of 
the neck are so frequent and so large, that the patient soon 
dies from the loss of the blood flowing through the branches 
of the uninjured carotid. 

In wounds of the body which do not penetrate the cavities, 
it is generally impossible to stop the bleeding from large arte- 
ries by any other means than by tying the arteries, or by stuff- 
ing the wound with lint and placing a firm bandage over the 
compress. When the last method succeeds, it is very impro- 
per to remove the lint or dress the wound, without advice, in 
less than forty-eight hours. Even then, if the lint adheres 
firmly, or the wound is covered with a coagulum of blood, it 
is wrong to disturb it, until nature herself loosens it. Lint 
should never be used in cuts unless under necessity, for it de- 
stroys the chance of healing the wound immediately. In all 
incised wounds, heat or ablutions with warm water promote 
bleeding, while cold tends to lessen it. 

He who studies the foregoing directions will be prepared 
to render all the assistance in checking hemorrhage from in- 
cised wounds which can be safely undertaken by those who 
are not of the profession. 

Mode by which Nature effects the cure of incised Wounds. 
There are two modes by which nature heals incised wounds. 
The first of these is called healing by the first intention, and 
can only take place when the sides of the wound can be kept 
nearly or quite in contact, and when the bleeding can be 
stopped without much handling. 

Soon after the wound is made, the blood vessels around the 



240 OF INCISED WOUNDS. 

cut throw out a kind of glutinous secretion, which adheres to 
both surfaces of the incision; and when the edges are kept 
close, rapidly grows harder and more adhesive, filling all the 
little intervals of the wound, and binding the sides together. 
In twenty-four, or forty-eight hours, this secretion becomes 
pretty solid, and new communications are formed in it, between 
the blood vessels on the opposite surfaces. A few days, or 
weeks, according to the extent of the injury, render the new- 
formed bond as firm or firmer than the original structure. 
Such is the simple manner in which wounds unite when no 
large arteries are wounded, when no unnecessary washing or 
handling is resorted to, when the parts are kept together and 
at rest, and when no nostrums or stimulating applications are 
applied "to hasten the healing." 

A little coagulated blood between the lips of a wound will 
not prevent this kind of union, if the orifice be well protected 
from the air, and the lips pretty strongly pressed against it, 
for it is generally absorbed before the glutinous fluid loses its 
character. Even larger coagula are often left under deep flaps 
in some incised wounds, where they are be} 7 ond reach, and 
the parts healing rapidly over them, they may give no trou- 
ble. If there should be a small cavity at the bottom of a large 
wound where the sides cannot be kept in contact, (as when a 
muscle is divided and its fibres retract,) it is better that it 
should continue to be filled with blood than with any thing 
else, as this fluid is less irritating than any other. But it is an 
important general rule that the bleeding should be stopped 
and all coagula removed before attempting the first dressing 
of an incised wound, as the neglect of this rule very often oc- 
casions an abscess or an ulcer; for blood, when long in contact 
with the air, becomes highly irritating, and in many persons 
it is difficult for the absorbents to remove a large coagulum, 
even when a wound has healed over it. 

If the edges of an incised wound cannot be brought quite 
together, if the bleeding vessels require time in taking them 
up or stopping them, if balsams or other stimulating applica- 
tions are applied, as is often foolishly done under the idea that 
these nostrums are "good for fresh cuts," or, lastly, if the bad 
state of the constitution bring on inflammation in the wound, 
— then the union by the first intention will often fail to be ac- 
complished, and the injury must recover by what is called 
union by the second intention. Still it is of great importance, 
except when the wound is inflamed, to keep it as nearly closed 
as possible by the dressings, in order that the cure may be as 
rapid as possible, and that some part of the cut may unite im- 
mediately, so as to diminish the labour of nature. 

In union by the second intention. The vessels pour out 



UNION BY THE SECOND INTENTION. 241 

the same glutinous fluid that has just been mentioned ; but this, 
instead of binding the sides of the wound together, appears to 
become converted into a kind of new membrane, covering the 
whole surface, and soon taking on the characters and functions 
of a living organ. In a few hours this membrane itself begins 
to form a new secretion, differing in character from any thing 
seen in the sound and healthy body. This secretion is called 
pus, or more commonly matter, and is too well known to 
need any description. Beneath this [me and perfectly trans- 
parent membrane, the capillaries enlarge themselves, and, per- 
haps, increase in number until the surface, when washed or 
cleansed, appeal's as red as if it were composed entirely of 
translucent blood vessels. These capillaries not only supply 
the new membrane wilh the fluid necessary to furnish the pus 
which bathes the wound, but they also deposite a kind of glu- 
tinous matter in the cells of the cellular tissue all around the 
cut, causing it to swell up. and gradually fill the cavity of the 
wound with a multitude of little conical eminences called gra- 
nulations, which look like flesh, but. are really composed of 
cellular membrane coloured by innumerable little blood ves- 
sels. Wherever these granulations come together, whether 
in consequence of their own growth or the dressings of the 
surgeon, they soon unite, and the secretion of pus ceases in 
that spot. At length the constant growth of the granulations 
fills up the whole cavity nearly or quite to the level of the sur- 
rounding surface, and then the new membrane gradually dries 
and takes on a character somewhat like that of the skin, the 
change commencing at the edges, and tending toward the cen- 
tre. This is called the cicatrization of the wound. 

After the cicatrization of the wound, the absorbents soon 
take up the glutinous matter secreted in the cellular tissue, to 
form the granulations; and the new scar with the parts beneath 
begin to contract with great force, drawing together the ori- 
ginal sides of the divided parts. It is this strong contraction, 
which cannot be prevented, that produces the terrible defor- 
mity from wounds or other injuries, when large portions of 
skin have been entirely destroyed, as we sec in burns. 

Such is the history of union by the second intention in in- 
cised wounds, when the patient's constitution is healthy, and 
the case not tampered with by ignorant pretenders; but many 
trivial causes may interrupt the process. If the discharge of 
the pus be prevented by closing the wound too tightly, it col- 
lects within, and its pressure not only prevents the granulations 
from forming, but causes the cavity to enlarge like an ab- 
scess. If inflammation attack the part, or if the wound be 
left so much exposed that the air causes the pus to become 
sour or bad, the granulations do not fill up the cavity, but it 

31 



242 TREATMENT 

degenerates into an nicer. In certain states of the constitu- 
tion or conditions of the part, the granulations are rendered 
large and weak, rising up beyond the surface of the skin, and 
forming what is commonly called proiul flesh: over this the 
wound either refuses to heal, or, if it unite at all. continues ex- 
ceedingly liable to re-opening from slight injuri 

After these remarks, the reader is prepared to understand 
the treatment of incised wounds. 

Treatment. — The Weeding being stopped, the next thing 
required is to secure the union by the first intention of the 
whole wound, or as large a part of it as possible. All that is 
required in dressing for this purpose is to close the wound and 
keep it closed, — and the following are the proper measures. 

The suture or stitching. It is a very popular prejudice 
that large wounds generally require to be sewed up. A good 
surgeon very rarely uses a stitch, except in wounds of the 
eyelids, nose, lips, or ears, when it is impossible to use stick- 
ing plaster, or bandages so as to close the wound. It occa- 
sionally happens, however, that a cut is made many inches in 
length, and in an angular or very irregular direction, so that 
it cannot be closed throughout its whole length without a su- 
ture, and we may then place one or two stitches at the angles 
with advantage: but these should only be regarded as as 
ants to the sticking plaster or bandage, and the attempt to sew 
up the whole length of a wound of any ordinary dimensions, 
or even to close a part of it by a regular seam is justly regard- 
ed as horribly bad surgery. Each stitch must be separate, 
and should be taken in the following manner. 

Take one, two or three threads of sewing silk (the unco- 
loured is best.) about six inches long, and well waxed; pass 
this ligature through the eye of a darning needle, if no curved 
surgeon's needle be at hand — giving preference to the com- 
mon Dutch needle, if possible, for these arc much less likely 
to break than those made of steel. Pass the needle through 
the skin, from one side of the wound, directing it from with- 
in outward, so as to pierce the skin about half an inch from 
the cut, unless it be in a very delicate part, like the eyelid — 
taking care to include the whole thickness of the skin, which 
varies from the eighth to the half of an inch indifferent places. 
Having drawn the ligature through until its middle lies in the 
wound, detach the needle entirely, and thread it with the 
other end of the ligature: then beginning in the wound below 
the skin, bring it out in the same manner on the opposite side. 
The stitch is then complete, and it only remains to tie the 
ends of the ligature, either in a single knot, or in the sliding 
noose, usually called a booby's knot The stitches should ne- 
ver be tied tighter than is barely sufficient to cause the edges 



OF INCISED WOUNDS. 243 

of the wound to touch each other gently, and all strain should 
be taken off by supporting the rest of the wound by strips of 
sticking plaster or the bandage. If the parts become swelled 
or inflamed, the stitches must be cut immediately, and as soon 
as the part adheres sufficiently to need them no longer, they 
should be divided and drawn out. Clumsy operators and 
those who have not received a regular medical education make 
much more use of the suture than those who are experienced. 
The writer of these pages, in treating some hundreds of cases, 
including many wounds of the eyelids, nose, lip, tongue, and 
ear, has never had occasion to employ a stitch, except in three 
instances. 

Adhesive strips, or pieces of sticking plaster, are by far the 
most important means for closing incised wounds. Although 
their use is so well known that it is unnecessary to explain 
what is meant by them, there are some precautions in apply- 
ing them which require notice. It is best to make them as 
broad as convenience will permit, provided the wound be not 
exceedingly short, or seated on a very irregular part. They 
should be not less than six or seven inches in length for large 
wounds of the body or extremities, and as long as possible for 
those of the face, hands, feet, <S:e. They ought never to be ap- 
plied lengthwise to the wound, but should cross its course in the 
way best calculated to keep the sides together. We must never 
permit them to cover the whole wound, for it is necessary to 
allow short intervals between the strips in large wounds, and 
the ends of the cut should never be quite covered, however 
small it may be, in order that blood or pus, if any occur, may 
escape without parting the sides of the wound. A strip of 
adhesive plaster should never be permitted to encircle the 
whole limb, for its pressure would then tend to embarrass the 
circulation by acting like a ligature and preventing the return 
of the blood through the veins. In wounds running length- 
wise of the fingers, it is absolutely necessary to employ strips 
which would pass several times round the part ; but the difficul- 
ty can be generally conquered by winding the strip in a spiral 
direction, so as to allow the capillary circulation to be conti- 
nued round the intervals between the turns. 

When any of the blood vessels of the wound have been tied 
to prevent bleeding, one end of the ligature is always cut off 
close to the knot, and the other must be left long enough to 
project from the wound, in order that the ligature may be 
drawn out when it has separated from the end of the vessel, 
an occurrence which takes place in from three days to as many 
weeks, according to circumstances. These ends of the ligatures 
most be permitted to pass freely through the intervals between 



244 TREATMENT 

the adhesive strips, and, if possible, it is best to bring them 
out at one angle of the wound, preferring the lowest angle, in 
order that the pus which always forms along the track of the 
ligature may flow out most easily. 

When the wound is fairly closed by the adhesive strips, a 
small piece of soft rag or patent lint covered with simple oint- 
ment, should be laid over the whole, taking care not to cover 
a great deal of the surrounding skin or the ends of any of the 
strips with the salve, as this loosens the sticking plaster and 
irritates the surface. This ointment prevents the discharges 
from the wound from becoming dry, and rendering the neces- 
sary removals of the dressings painful to the patient. 

The first dressing should never be removed in less than for- 
ty-eight hours without strong necessity, or the commencing 
adhesions will be torn, and the wound re-opened. In taking 
off the sticking plaster, we should always begin at both ends 
and pull the strips by doubling them back and drawing toward 
the wound. Tf the parts be covered by long hairs they should 
be well shaved before applying the plaster, and if the strips 
in coming off adhere to the small hairs, these should be cut 
with a sharp knife as we proceed. All the rg after the 

first should be repeated every twenty-four hours in warm wea- 
ther, and at least every forty-eight hours in winter. 

Bandages. Whenever an incised wound is situated on a 
moveable part — such as the neighbourhood of the joints — and 
whenever the cut is very deep or extensive, it is apt to 
or to be dragged open on every attempt at motion. It is then 
highly important not to trust the closing of the wound entire- 
ly to the adhesive strips, but we should support the part with 
a bandage, and confine it in a state of absolute rest. Thus a 
deep cut across the front of the arm would be opened at 
every attempt to straighten the forearm, and it is nece-- 
to keep the arm in a sling in order to prevent this accident, 
and if a deep cut lengthwise of the arm shows a tendency to 
gap, it is proper to confine the whole arm in a spiral bandage, 
such as surgeons call a roller, in order to assist the ad he; 
strips by pressing the edges together. 

Whenever we employ rollers on either of the extremities, 
it is proper to begin at the fingers or toes, where the ban g 
should always be tightest, and to continue it gradually up the 
limb until we have passed the wound and its dressings. This 
is done to prevent the pressure of the roller from acting like 
a ligature and embarrassing the circulation in the veins below 
it. More will be learned by seeing a roller once properlv 
applied by an accomplished surgeon, than by many pages of 
description; and all that we can now offer the reader on this 
subject is. 1st, never to employ a bandage o( more than 



OF INCISED WOUNDS. 245 

and a half fingers' breadth for the arm, or three fingers' breadth 
for the leg; 2d. to use for all their rollers the common domestic 
bleached, but unglazed muslin, at from 10 to 15 cents per 
yard; 3rd, never to sew separate strips together to make a band- 
age, if this can be avoided; 4th, always to make the turns of the 
roller overlap well; and lastly, never to allow the bandage to 
be creased or rumpled where it touches the skin. 

Splints. In all wounds running crosswise on the fingers 
or in certain places about the larger joints, it is always ad vise- 
able and often absolutely necessary to resort to other measures 
than the adhesive strips and bandage in order to control the 
motions of the neighbouring joints, and secure the wound 
from being torn open inadvertently. For this purpose we 
employ splints, or strips of some firm substance, to extend 
along the limb, generally from its extremity to the joint next 
above the wound. These are bound on by means of a roller 
passed round both the limb and the splint* 

There are a great many different kinds of splints employed 
by surgeons, but only two varieties can be employed in do- 
mestic practice with any propriety. These arc the paste- 
board splints, and the wooden splints. 

Paste-board splints arc best made of the thickest book- 
binder's board, or — if great strength be required — of two of 
these boards strongly glued together. The splint being cut to 
the required length and breadth, by means of a strong jack- 
knife, is to be dipped into, or passed through boiling water for 
a few seconds only, until it will bend in any direction without 
breaking; but it must not be soaked so as to make it very soft. 
It is then placed on the limb and secured by a pretty tight 
roller, which causes it to assume the form of the parts on 
which it presses, and in a few hours it becomes permanently 
moulded to that form by drying. 

JToodcn splints should be made of panel white pine, ce- 
dar, or ash, the two former being preferable in most cases, be- 
cause they arc so readily cut by a pen knife. The wooden 
splints which are required in all wounds of the extremities 
except perhaps those of the thigh, are best made of a smooth 
common shingle, plained down until reduced to one half, or 
one third the thickness of the butt: a splint of any shape can be 
cut out from this with a pen-knife in a few moments, and the 
edges and angles being rounded off it is ready for use. Seve- 
ral shingles thus prepared should always be ready in case of 
accident, in every large establishment, and on all considera- 
ble plantations. 

Before a splint is finally applied, it should always be lined 
with tow or cotton, and if of wood, this lining should be bound 
on to it by a bandage or piece of smooth muslin. We shall 



246 OF INCISED WOUNDS BY GLASS. 

speak further on the subject of splints in mentioning the in- 
cised wound of particular parts. 

Of incised wounds by glass. It is very important to men- 
tion that cuts made by glass form an exception to the general 
rule in the treatment of incised wounds. It is almost impos- 
sible to tell when we have removed the last fragments of such- 
a transparent substance, and if the wound should heal, as ifc 
may often be made to do, over a piece of glass concealed be- 
neath the skin, the consequences are often very troublesome, 
and sometimes dangerous. For this reason glass wounds 
should never be united by the first intention, but should be 
dressed for at least two days with a plain bread and milk poul- 
tice, introducing a little common lint between the edges of 
the wound before applying the poultice, if the cut be deep and 
narrow. Afterwards the wound will unite by the second in- 
tention, and the granulations, as they rise, will thrust out any 
portions of glass remaining in the cavity. 

If we fail in causing the union of the whole of an incised 
wound by the first intention, we can almost always succeed 
with the greater part of it; and very little variation in the 
treatment is commonly required to effect the union of the re- 
mainder by the second intention. The same care continues 
to be necessary in keeping the wound closed as accurately as 
is convenient by adhesive strips, bandages, or splints. Stitches 
are generally cut away, when incised wounds begin to throw 
out pus, or suppurate; but this should not be done if removing, 
the stitch will put the parts upon the stretch, or cause the 
wound to gap very much. Greater care is now required to 
avoid allowing the collection of matter within the wound by in- 
terposing any obstacle to its escape. For this reason theadlu 
strips should be wide apart, and the end or angle of the wound 
which is calculated to drain it most completely should be 
made constantly dependent by fixing the limb or part in a 
proper position. If the wound be very large, and the dis- 
charge very great, the patient may require confinement to his 
bed to secure this position. More care is necessary in band- 
aging in these cases, and little compresses by the side of the 
wound may be often serviceable in keeping the deepest parts 
of the cut in contact. The simple ointment should cover a 
wider space in these cases, than in those which do not suppu- 
rate, to protect the pus in the wound from the action of the 
air. 

When inflammation comes on, if the orifice be wide, the 
wound becomes an ulcer; if narrow, an abscess or fistila; 
for the treatment of which, see the proper heads. 

Healing of incised wounds by scabbing. We sometime.- 
see slight incised wounds which do not gap much, and which 



OF INCISED WOUNDS OF THE SCALP. 247 

have remained undressed for some hours, covered either by a 
little scab composed of an excess of the glutinous fluid em- 
ployed by nature in healing wounds, or of coagulated blood, 
which after filling the cut has just covered the orifice and be- 
come dried there. Under such scabs the wounds generally 
heal slowly but surely, and if we attempt to remove them, 
particularly if the skin of the part be thick, as on the joints of 
the fingers, the palm of the hand, the sole of the foot, &c, we 
are apt to give cause to troublesome fissures or narrow sores, 
which it is sometimes very difficult to cure. It is best to 
leave these cases entirely to nature, or to rest content with 
merely oiling the scab a little when its contraction causes pain 
and irritation. In a week or two the crust falls off, leaving 
the parts well. 

Balsams, &c. A great many nostrums, such as the red oil, 
spirits of turpentine, various balsams, &c, are strongly recom- 
mended as excellent for fresh cuts! It is useless even to name 
these articles, for although some of them may prove servicea- 
ble in bruises, contused wounds, and punctured wounds at cer- 
tain times, and under certain circumstances, the application of 
any remedy to the interior of a "fresh cut" is utterly absurd 
and ridiculous! — it inevitably interferes with the first great 
object of nature, — the union by the first intention. 

We will now proceed to speak of some peculiarities of treat- 
ment required by incised wounds of particular parts. 

Incised wounds of the scalp. Most wounds of the scalp 
are made with instruments or bodies much duller than those 
which produce incised wounds in other parts; but the power 
of the scalp to adhere by the first intention, exceeds by great 
difference, that of any other part of the body; and even when 
this part is torn or lacerated by falls or other accidents, the in- 
jury should always be treated like an incised wound. 

I have seen nearly half the scalp of the top and left side of 
the head, a large portion of the skin of half the forehead, the 
external angle of the left eye and the whole of the left temple 
torn up, turned back, and covered with chips, dirt, and brick 
dust, in consequence of the head being caught in falling be- 
tween the hub of a cart-wheel and a high pile of boards, yet, 
when washed and replaced, the whole united by the first inten- 
tion, except the parts about the corner of the eye, and one spot 
on the temple where it was necessary to tie an artery, and 
where the ligature prevented the immediate healing. The 
connexion between the loose flap and the head was formed 
just above and behind the ear, and did not exceed three inches 
in length; — yet the scar left on the forehead and temple does 
not appreciably diminish the remarkable beauty of the young 
man who was thus horribly injured. 



248 OF INCISED WOUNDS OF THE NECK. 

In wounds of the scalp, unless they extend to the temple, 
where there is a thick muscle covering the bone and one large, 
though not very important artery, the cases requiring ligatures 
are exceedingly rare, for all bleeding is easily checked by 
pressure with a compress and bandage. Stitches are never ne- 
cessary, and sometimes prove highly dangerous. 

After removing every trace of dirt or other foreign matter 
by washing with a sponge and milk-warm water, the next 
thing to be done is to shave the head well and freely for se- 
veral inches round the wound. The edges being drawn to- 
gether by the adhesive strips, and the simple ointment applied, 
the whole dressing should be kept in place by a large hand- 
kerchief applied as the French do in making their common 
head-dress, or by a close-fitting night-cap. If any little ab- 
scesses should form under a flap of scalp while the rest of the 
flap is uniting, they should be opened early with a thumb- 
lancet. 

Incised wounds of the neck and throat. Those wounds of 
the neck which neither wound a large artery nor open the 
wind-pipe, arc not generally difficult to treat. If they run across 
the front or side of the neck, they never require stitches; but 
to aid the sticking plaster in keeping them from gaping it is 
best to fix the head in a night-cap and tie it in such a manner 
as to draw the head downward toward the wound. When 
long wounds run lengthwise of the neck, it is wrong to apply 
adhesive strips too tightly, for fear of embarrassing the circu- 
lation of the head; but the skin of the neck is so loose that we 
can always close a wound of this kind without making them 
tight. No bandage should ever be applied all round the neck; 
but if a salve be wanting over the strips, it must be kept in 
place by other strips crossed over the dress; 

When large blood vessels are wounded, none but the ablest 
surgeon can be of any use unless for a few moments, and in 
the manner pointed out at the commencement of this section. 

When the wind-pipe is opened extensively, the patient can- 
not breathe except through the wound, which gapes horribly, 
and the voice is destroyed. Many small blood vessels are di- 
vided, and if the wound be accurately closed, the blood is apt 
to flow into the lungs and strangle the patient. For this rea- 
son the suture must never be employed to close the skin in 
front of the wind-pipe, which should be left very slightly open 
for a drain. Stitches may be occasionally serviceable at the 
corners of the wound by contracting its extent, and practised 
surgeons sometimes venture to draw the ends of the wind-pipe 
itself together by stitches passed through the cartilages of that 
tube; but the only mode of keeping the edges of the wound so 
near together in front as to give a fair chance of an early cure. 



OF INCISED WOUNDS OF THE CHEST. 24i* 

is by bringing and confining the head as far forward as possi- 
ble by means of a cap with strings attached to a band passed 
round the chest, and in order to prevent the introduction of 
dust with the breath, the wound must be covered with fine 
gauze. Of course no individual unconnected with the medi- 
cal profession would have the madness to attempt the treat- 
ment of a wound of this character, except when compelled to 
do so by dire necessity. 

Incised IVounds of the Chest. If these wounds are not deep 
enough to reach the cavity of the chest, they require no pecu- 
liar treatment. If they do open the cavity, the lungs on the 
corresponding side instantly collapse, half the chest becomes 
filled with air, and the patient breathes with great difficulty 
by the other side of the chest only. Blood often flows inter- 
nally, and inflammation of the pleura and the lungs are the in- 
evitable consequence. There is frequently a rushing of air in 
and out of the wound with every effort to breathe, and if the 
lungs themselves are wounded, there is generally a cough and 
6pitting of blood. After closing the wound by adhesive strips, 
it is necessary to be very careful to prevent any danger from 
the wound being forced open and the dressings being drawn 
into the chest by the rush of air in breathing; so that if the 
lungs be not wounded it is generally best to cover the strips 
with a large piece of fine linen, the centre of which should be 
spread with simple ointment, and the whole secured by a very 
broad bandage round the chest, to which the edges of the linen 
may be pinned or stitched securely. A surgeon should then 
be procured as soon as possible. 

If the bleeding be very great, flowing out more freely when 
the patient performs the act of expiration, the wound should 
be covered with a thick firm compress bound on in such 3. 
manner as to arrest the flow entirely until the surgeon arrives, 
and the patient should repose on the side next the wound. 

In those cases of wounds of the lungs which bleed with ra- 
pidity, the lancet must be used without scruple; the most abso- 
lute rest and freedom from excitement both of mind and body 
are requisite; and the diet as well as the general treatment 
must be such as to reduce the patient as rapidly and as low as 
possible, until the hemorrhage is checked and the violence of 
inflammation is over. After this, the management of such 
wounds requires great skill, and depends too much upon the 
peculiarities of individual constitutions to fall under any gene- 
ral rules. Deformity of the chest, chronic pain, and perma- 
nent difficulty of breathing are common results of the most 
successful treatment, and these cases always display a fearful 
contest between death, the powers of nature, and the resources 
of ^rt. If pieces of clothing, dressings, or large quantities of 

?>2 



250 OF INCISED WOUNDS OF THE ABDOMEN. 

blood find their way into the cavity of the pleura, trouble- 
some abscesses, fistulas, and other accidents, sometimes re- 
quiring severe surgical operations, and putting life to risk long 
after the patient rises from his bed, are often among the ulti- 
mate consequences of these formidable injuries. 

Incised Wounds of the Mdomen. In healthy constitu- 
tions, superficial wounds of the abdomen are, for the most 
part, of little consequence. Unless they occur near the rim 
of the belly, they can scarcely occasion very troublesome 
bleeding, as there are but two very important arteries on the 
whole anterior surface. If these wounds be deep enough to 
divide any of the muscles or tendinous expansions, there is 
danger of hernia or rupture occurring sooner or later at the 
spot where the cut is made; and hence, after accurately closing 
the wound by adhesive strips, we should apply a pretty thick 
compress of folded muslin over the dressings, and bind it ra- 
ther firmly by means of a bandage, to prevent the bowels from 
thrusting the perineum into the wound. This compress should 
be worn for some weeks after the parts have healed, in order 
that they may acquire as much firmness as possible, and the 
bowels must be kept free by fluid diet and medicine. 

Even if the cavity of the abdomen be opened — unless the 
opening be extensive or the bowels be wounded — the case 
need not necessarily prove serious. The wound should be 
closed as quickly as possible, and if it unite by the first inten- 
tion, no farther difficulty need be expected, except from the 
tendency to hernia, which must be guarded against by the 
means already pointed out. The best diet is rye mush and 
molasses, and the best purgative is oil; but small doses, occa- 
sionally, are all that can be required, for two evacuations per 
day are as much as should be permitted. 

If the cavity of the abdomen be extensively opened, with- 
out a wound of the intestines, these instantly start out at the 
wound, and soon swell to such a degree as to make it very 
difficult, if not impossible, to return thrm. If a surgeon can- 
not be obtained immediately — as in country situations and on 
extensive plantations — this is one of the cases in which an in- 
telligent man of great nerve and prudence may save life by 
offering timely aid. The bowels may be handled with a fine 
and very soft towel, damped in water at about, or a very little 
above, blood heat; and if any foreign matter adhere to them, 
it may be washed off with a soft sponge,* properly prepared 
by the apothecary. 

These wounds always require stitches, and these must be 
passed deeply, and brought out at least half an inch from the 

* Common sponge must never be used, a* it always contain* impir 



OE INCISED WOUNDS OF THE ABDOMEN. 251 

wound on each side. They should never pass quite down to 
the cavity of the abdomen, unless applied by a surgeon, but 
they may include a portion of muscle with perfect propriety, 
if there be any in the way. The bowels being held aside by 
an assistant, the operator takes a stitch about an inch from one 
corner of the wound, and ties it: he then proceeds in the same 
manner at the other corner; and, after reducing as large a part 
of the protruded bowels as possible, he continues applying 
stitches alternately on each side, at distances of an inch, re- 
ducing a portion of the remaining bowel after forming each 
knot, until the whole mass is nearly secured within the abdo- 
men. If any portions of bowel show a disposition to protrude 
between the stitches, these must be carefully reduced before 
applying the long strips of sticking plaster, which should fill 
up all the intervals of the suture. A broad piece of lint, spread 
with simple ointment or lard, over the whole, completes the 
dressing, for no bandage should be employed. 

During both the dressing of the wound and the after-treat- 
ment, till the wound heals, the patient should lie on his back, 
with his hips and shoulders raised by pillows, so as to relax 
the abdominal muscles as much as possible; he must not be 
permitted to rise from his bed on any account, and his evacu- 
ations must be received in a bed-pan. 

Strict, low diet should be enjoined; and if the intestines 
be not wounded, the patient may drink freely. Purgative 
medicines, by mouth, ought not to be given, for fear of ex- 
citing the abdominal muscles, but the bowels may be kept 
open by laxative injections. 

Even if we fail in uniting by the first intention incised 
wounds of the abdomen which open the cavity without 
wounding the intestines, nature generally effects adhesions on 
all sides, between the bowels and the internal edges of the 
wound, so as to prevent the inflammation from extending to 
the whole cavity; and the wound may then heal by the second 
intention without danger. But these adhesions are sometimes 
imperfectly formed, and then the inflammation spreads. When 
this is the case, the patient must be most freely bled, and eve- 
ry thing must be done to avoid the slightest irritation of the 
bowels. This disposition to general inflammation of the ab- 
domen may be perceived by the increased heat of Ihe belly, 
an increasing tenderness when touched, obstinate costiveness, 
sickness of stomach, vomiting, and hiccough. When the two 
latter symptoms occur, the patient is in extreme danger, and 
will rarely recover. 

When the bowels are protruded in large incised wounds, 
and one of them is found to be wounded, the treatment de- 
fends much on the extent of the wound in the intestine. If 



252 OF INCISED WOUNDS OF THE JOINTS. 

this does riot extend more than one-fourth round the bowel, 
it may sometimes be stitched to the side of the wound, and 
the remainder of the cut may be closed and treated in the 
usual way, leaving the feces to escape for a time, until, by 
bandage and compress, the opening can be healed over, and 
the natural route re-established. If the wound divide the half 
or the whole circumference of the intestine, the two divided 
ends must be drawn out completely to the surfaces of the bel- 
ly, and there secured, while the attempt is made to heal the 
rest of the incision. This leads to the establishment of an 
artificial anus, and reduces the patient to a condition which 
would be much worse than death, were it not that the advance 
of surgery has furnished us with two modes of operating by 
which some of these cases may be ultimately cured. 

What has been said on wounds of the intestines, is merely 
intended to convey general information to the-reader, and (he 
author has no idea that any one not connected with the pro- 
fession, will have the folly to tamper with cases of this terri- 
ble nature. 

Incised ^Founds of the Joints. It is of the utmost im- 
portance that those wounds which lay open a joint should be 
closed as speedily as possible, for if the orifice should gap for 
a few minutes only, a general inflammation of the whole joint 
is almost sure to follow. This is an extremely troublesome, 
and — if the joint be a large one, such as the ankle, knee, or el- 
bow — a highly dangerous accident; for the symptomatic fever 
always runs very high, and the discharges of pus, mingled 
with the natural secretion of the joints, exhaust the strength 
of the patient. If he escape the violence of the fever, and 
bear up under the exhaustion, he is still liable to sink 
from the formation of small abscesses in the lungs or liver; 
and, if this danger also passes by, he almost invariably reco- 
vers with a stiff limb, which, if its position during the reco- 
very be left to chance, is often an incumbrance during the re- 
mainder of life. 

The orifice in cases of this kind should be closed as accu- 
rately as possible, and should be held so by adhesive strips. 
If a surgeon be not immediately at hand, this should be cer- 
tainly done without waiting for the arrival of one. The ad- 
hesive strips having been adjusted, there will be generally an 
oozing of some blood between them. A light compress of 
muslin or lint, without ointment, should be bandaged over the 
cut, and the blood soaking into and beneath this compress, will 
coagulate over the incision so as to exclude the air. This- 
compress should not be disturbed for several days, unless 
by a professional adviser, but the bandage may be removed 
from time to time, if necessary. It is absolutely nece?r 



OF INCISED WOUNDS OF THE JOINTS. 253 

that the part should be preserved in a state of perfect rest, for 
the letfst motion of the joint may be attended with the most 
serious consequences; and it is therefore proper to apply a 
long splint in all such cases, so that the patient may be de- 
prived of the power of moving the limb even during sleep. 

When any symptoms of tenderness or inflammation appear, 
leeches must be freely applied, and the first appearance of fe- 
ver should be met by the liberal use of the lancet, saline pur- 
gatives, and strict, low diet. 

If we fail in accomplishing the cure by the first intention, 
the joint will soon become violently inflamed; the synovia, or 
the fluid which fills the cavity, flows freely, mingled with the 
pus from the wound. The dressings must then be thrown 
aside : and a bread and milk poultice, changed twice a day, be- 
comes the best local application; but in these formidable cases 
the life of the patient depends for the most part upon prompt 
and vigorous general treatment, varied from time to time, ac- 
cording to the peculiar constitution and condition of the indi- 
vidual. It would be worse than folly to lay down rules for 
their treatment in a popular work, and the highest accessible 
surgical talents must be called in requisition. 

We will now conclude our remarks upon incised wounds, 
with some important directions in relation to superficial 
wounds in the neighbourhood of joints, and the position in 
which the limb should be kept in order to prevent the mo- 
tions of the part from putting the cut on the stretch. 

In all wounds about the arm-pit or shoulder, after the dress- 
ings are completed, the arm should be bound lightly to the 
side by three or four turns of a broad bandage, and the fore- 
arm should be carried in a sling. A sling is equally necessa- 
ry in all cross cuts about the front of the elbow; but when a 
long or deep wound takes place across the back of the elbow, 
the arm should be kept perfectly straight, by a wooden splint 
extending from the ends of the fingers, and this splint should* 
not be relinquished until the parts have been healed for some 
days. In similar cuts about the wrist or the back of the hand, 
the splint should extend from the middle of the fore-arm to 
the ends of the fingers. It is even proper to apply a little 
splint in cuts on the back of the ringers, especially if they 
cross either of the joints, for these injuries often become ex- 
tremely troublesome where motion is not entirely prevented. 
If one finger only be wounded, a narrow splint, running from 
the middle of the palm to its extremity, will be sufficient 
for all purposes, and will be found much less annoying tharr 
a larger one; but, if several fingers are hurt, the whole hand- 
should be confined upon a splint, 



254 OF LACERATED WOUNDS. 

Wounds of the groin require that the patient should be con- 
fined on his back in bed, with his body raised nearly to a half 
sitting position by pillows; and most incised wounds of the 
leg and foot may be treated by placing the limb in a straight 
posture, and ordering the patient to keep it so: splints are very 
rarely necessary. 

Wounds of the heel made with the axe are not uncommon, 
and require especial notice. This part contains a most pow- 
erful and important tendon, called the tendon of Achilles, from 
the old Homeric legend in relation to that hero. All the large 
muscles which extend the foot and enable us to rise on the 
toe are attached to the principal bone of the heel by means 
of this tendon; and if it be divided, the upper part of it is 
very soon drawn up far away from the inferior part. If it 
unite in this situation, the new bond of union always remains 
weak and extensible, so that the command of the foot is in a 
great degree lost. 

If the tendon be completely divided, the advice of a sur- 
geon is absolutely necessary to prevent incurable lameness; 
but if it be only partially severed, the chances are much bet- 
ter. In either case, the best domestic treatment consists in 
bending the leg at right angles with the thigh, and binding 
upon the foot a splint cut into the form of the sole of a shoe, 
but with an extremity projection; six or seven inches behind 
the heel, on the under surface of which extremity should be 
tied the end of a broad piece of roller, [bandage.) about a 
yard, or a yard and half in length. This roller is intended to 
be thrown smoothly over the back part of the leg and round the 
front of the thigh, being then returned, to be tied at the place 
of its commencement. It thus keeps the foot strongly extended, 
with the toes pointing downward, without interfering with the 
dressing of the wound, and without embarrassing the circula- 
tion, as it would do if the bandage were made to pass all round 
the limb, instead of merely pressing upon its posterior part. 
After the splint is applied, the knee should be bent, the wound 
dressed, and the patient confined in bed, with the limb in this 
flexed position, which should never be changed during the 
treatment. The foot should not be put to the ground for six 
weeks at least, and no force in walking should be exerted for 
three months after the accident. 

Of Lacerated Wounds, or such as are made by instruments 
which tear. 

The principal difference between the condition of a lace- 
rated and an incised wound, consists in the perfectly healthy 
condition of the edges in the latter, and their injured state in 
the former accident. The parts about the immediate neigh- 



OF LACERATED WOUNDS. 255 

bourhood of a lacerated wound are not divided nicely in the 
precise direction of the instrument which makes them, but 
are torn off, sometimes on one side, and sometimes on the 
other. They, therefore, present rather a multiplicity of frac- 
tures of particular fibres than a clear cut. These fibres are, 
therefore, found in a debilitated condition, and illy calculated 
to resist the force of the general circulation which is natural- 
ly increased for the purpose of supplying the repairs for the 
lost and injured parts. The energy of the vital operations 
going on in these weakened parts is greater than they can 
bear consistently with health, and they are, therefore, ex- 
tremely liable to become inflamed. Of course, then, there is 
much less chance of union by the first intention in lacerated, 
than there is in incised wounds, but this chance is much 
greater in some places than in others. A complex organ or 
tissue, like the skin or a muscle, unites with great difficulty, 
because the injury done by the tearing instrument is greater 
in proportion to the strength of the fibres, and the power of 
healing is less in proportion to the amount of interstitial mat- 
ter included in the cellular tissue of the part. — (See Sect, on 
the Reproduction of Parts, p. 133.) In such situations, then, 
inflammation almost invariably follows a lacerated wound, and 
it is only after the subsidence of this inflammation that the 
edges of the wound are able to unite even by the second in- 
tention. In the soft, pasty, free cellular tissue intervening be- 
tween the different organs, it matters very little in what di- 
rection a wound takes place, and comparatively slight mischief 
is done by laceration. Such parts often unite by the first in- 
tention, so as very much to diminish the extent of the wound 
and the danger of exhaustion to the patient while all the other 
portions are suppurating freely. 

Few parts are so extensively or seriously injured by lace- 
ration as the blood vessels; and hence follows a consequence 
of great importance. 

When blood comes into contact with dead or very debili- 
tated animal matter, it has a strong tendency to coagulate, and 
when it reaches the torn and collapsed vessels around a lace- 
rated wound, it generally undergoes this change, so as to clog 
and shut up their open mouths. Lacerated wounds, there- 
fore, seldom bleed much, unless the larger blood vessels are 
opened. 

These wounds also produce a much more powerful impres- 
sion on the system in general than those which are made with 
cutting instruments; for when they are at all severe, the pa- 
tient sinks immediately into a more or less complete collapse: 
the general circulation is rendered extremely feeble, and hence 
there is little or no bleeding for some time, even when the 



256 OF LACERATED WOUNDS. 

largest vessels are involved. It is only after the patient has 
recovered from the collapse, or, in other words, after the re- 
action has come on, that the danger from loss of blood be- 
comes imminent. The hemorrhage which then occurs is 
called secondary hemorrhage, and happens much more fre- 
quently in lacerated than in incised wounds. The arm, with 
the shoulder blade and collar bone, have been known to be 
dragged off by a machine, without producing bleeding! 

Two consequences follow from this injury to the blood ves- 
sels and the collapse of the system in lacerated wounds: 1st, 
It is unnecessary in most cases to tie the arteries; and when, 
from the large size of the vessels ruptured, or the occurrence 
of secondary hemorrhage, we are compelled to do so, the ar- 
tery wounded, or the main trunk which supplies the bleeding 
branches, must be taken up at a distance from the wound; for, 
if tied very near the lacerated parts, the ligature would ulce- 
rate out, and the hemorrhage might return during the absence 
of all competent assistance. Of course this operation can only 
be performed by a regular surgeon, and all that can be done 
by others is, in cases of great emergency, to plug the wound 
with lint if it do not communicate with any internal cavity, 
and to apply compresses and a bandage to check the flow of 
blood. 

In deep lacerated wounds, involving the large muscles, 
however they may gap, it is generally better to depend upon 
placing the part in the position best calculated to relax those 
muscles and approximate the sides of the wound, than to at- 
tempt to draw the edges together by stitches, which produce 
great irritation when they are carried deep, and are extremely 
apt to cut their way out through the bruised parts. Unprac- 
tised surgeons sometimes employ modifications of the suture 
with advantage in such cases, but unprofessional assistants can- 
not do so with any safety. When adhesive strips and regular 
bandaging can be employed in promoting the close of the 
wound, they should be resorted to: but this is seldom the case 
when the injury is extensive. The best mode of dressing 
small lacerated wounds, is to place directly upon them, or 
over the adhesive strips, a plaster of simple cerate, (see In- 
dex — Salves,) spread upon muslin or patent lint, so applied 
as not to cover a great deal of the surrounding skin. If the 
wound be large and gaping, a light, mild, warm bread and 
milk poultice, mixed with a little oil, should be applied, and 
regularly changed once a day in winter or twice a day in sum- 
mer, until granulations begin to fill the bottom of the wound. 
If the poultice be changed less frequently, it will either be- 
come hard and dry, or sour; and in either case it will act as 
a powerful irritant. In wounds of any considerable diqo 



OF LACERATED WOUNDS. 257 

sions if they become inflamed, hot and dry round the edges, 
the poultice should be employed, without regard to the pre- 
sence or absence of granulations: but in this condition of the 
parts, the poultice should be cold, prepared without oil, and 
more frequently changed. If the redness show any disposi- 
tion to spread generally and widely over the surrounding sur- 
face, there is danger of the occurrence of erj^sipelas, and the 
case requires a different course of treatment, as will be noticed 
hereafter. 

In all cases, it is of the utmost importance that the wounded 
part should be kept at perfect rest. 

A very good mode of treating lacerated wounds of the leg, 
is to place the patient on his back, with the limb on a pillow 
laid in a long narrow box, protected by a piece of oiled silk 
or muslin, or an India rubber cloth, and then covered with 
bran. The bran can be washed away with a little soap and 
water, and renewed at any moment. If the wound be small, 
the bran will often form a crust over it, beneath which it 
will heal kindly without the aid of any other dressing. 

When, in an incised wound, the granulations have nearly 
filled the cavity, and begin to rise in places a little above the 
surface, they sometimes form proud flesh, and require the ap- 
plication of a gentle astringent to give them firmness. A wash 
formed of the decoction of oak-bark or a little plain or burnt 
alum in powder, dusted on every day or two, will answer 
this purpose in most cases; but if the granulations be unusu- 
ally hard or very exuberant, it is well to touch the whole sur- 
face occasionally with lunar caustic; and if the skin around the 
wound appear extremely delicate and moist, with a disposition 
to throw off the cuticle before the new fine skin beneath is 
perfectly formed, then dusting with finely powdered chalk or 
carbonate of zinc will hasten the completion of the cure. 

Lacerated wounds of the chest, if they open the cavity, are 
almost certainly fatal, and little can be done for them but to 
exclude foreign substances by light dressings guarded by fine 
gauze. 

Lacerated wounds of the abdomen are not necessarily fatal. 
When large enough to require the suture, it should be em- 
ployed whenever the condition of the parts will admit of its 
use. The stitches should be carried as deeply as possible 
without entering the cavity, through muscle or fascia, but avoid- 
ing the peritoneum, and they should be brought out at least 
an inch from the edge of the laceration. In other respects, they 
are to be treated like the wounds already mentioned. The for- 
midable character of these accidents is sufficient to guaranty 
that their management will not be undertaken by incompetent 
hands. 



258 OF LACERATED WOUNDS. 

Lacerated wounds of the joints, and especially those of the 
ankle joint, may be sometimes treated on a plan widely diffe- 
rent, and with the happiest results. These accidents are often 
attended by displacements of the bone, and the dislocation 
must be reduced, or the portion of bone thrust through the 
skin removed, (which latter operation can be performed by a 
surgeon only,) before any attempt is made to close the wound. 
If, then, there be an oozing of blood from the torn surfaces, 
without a dangerous hemorrhage, the limb must be placed in 
the position best calculated to relax the edges; and if the form 
of the wound be such that a bandage properly applied will not 
close it completely or nearly so, some strips of adhesive plas- 
ter may be employed. If the nature of the accident precludes 
the possible introduction of any foreign substance, such as dirt, 
chips, &c. into the wound, the larger coagula of blood should 
be removed with the finger, but the part should not be washed. 
Stitches should not be employed. The wound being closed 
as accurately as possible, by the position of the limb, with or 
without the aid of adhesive strips, the operator applies two or 
three folds of patent lint over the whole seat of the injury. 
Then, if the form of the part require it, a compress of muslin 
is placed upon the lint, and the whole is enclosed in a proper 
bandage,accurately but not tightly applied. The patient must be 
strictly^ confined to his bed, and all motion of the joint pre- 
vented. If the knee, ankle or foot be the seat of the injury, 
the limb should be covered with bran over the dressings in 
the manner already described. In this mode of treatment the 
dressings are matted together by coagulated blood, which ad- 
heres strongly to the torn edges and the surrounding skin, be- 
coming too hard and dry to putrefy. Beneath this covering 
the wound heals like an internal laceration without suppuration. 

The bandage should not be removed to examine the d; 
ings unless inflammation or fever appear, or unless there be 
signs of moisture perceptible, showing the escape of a fluid 
discharge from the wound. When such symptoms demand 
our interference, we apply a very moist bread and milk poul- 
tice without oil, over the dressings, after removing or cutting 
off so much of the bandage as is not adherent to the lint and 
compress. A few repetitions of the poultice will bring off the 
whole mass of covering, and the wound must then be treated 
on the plan recommended under the head of incised wounds 
of the joints when they cannot be united by the first inten- 
tion, (p. 252.) 

When inflammation of a joint from a wound is once esta- 
blished, the use of the joint is almost always lost, and the pa- 
tient, if he recover at all, is usually confined for many months, 
and rises with an enfeebled or broken constitution.' In bad 



OP CONTUSED WOUNDS. 259 

lacerated wounds of joints, therefore, the question of the pro- 
priety of amputating the limb is always started. In the deci- 
sion of this question between the imminent risk of life or the 
permanent loss of health on the one hand, and the creation of 
a deformity on the other; involving also, in both cases, a con- 
siderable degree of disablement, — both the patient and the sur- 
geon are solemnly bound, to consider well the station, means 
of livelihood, social responsibilities, general health, and age 
of the sufferer. A poor or married man may be compelled to 
lose a leg to preserve which a rich or single man may afford 
to run great risk of life. A man of family is bound in honour to 
ensure his safety at the expense of a deformity, the conse- 
quences of which to the youth of high prospects or an unmar- 
ried female, may be worse than death. A man of indepen- 
dent estate may sacrifice a right arm where his humbler neigh- 
bour must run into any degree of danger rather than fall upon 
the world's cold charity. As a general rule, American sur- 
geons amputate too little, from a feeling of false pride in ac- 
complishing the difficult. 

Of Contused Wounds. In wounds of this class the parts 
around the injury arc much more extensively and deeply ia* 
jured than in either of the preceding varieties. Indeed the 
external wound is often of very little consequence in compa- 
rison with the bruise and its effects. The latter will be de- 
scribed under the head of contusions, and the former will re- 
quire but short notice here. 

The edges of the wound in these accidents are generally de- 
bilitated to such a degree that they are incapable of resisting 
the impulse of the circulation, quickened as it is by the acci- 
dent as soon as reaction is established. 

It therefore commonly fol.lows, either that the edges mor- 
tify and come off, or, that they are removed by the absorbents, 
as being no longer fit for restoration to health. Thus, generally, 
the wound is enlarged in the first instance, before granulation 
begins or any attempt is made toward healing. 

It follows, of course, that union by the first intention is out 
of the question, and it is no longer an object to close the wound 
in the first instance either by suture, adhesive strips, or the 
methodical bandage. When the injury is not very extensive, 
it is adviseable to apply poultices from the first; but as these 
applications are peculiarly debilitating in their effects, and 
must necessarily extend much beyond the limits of the wound 
itself, it becomes improper to use them when the surrounding 
parts are severely and extensively bruised, for fear of endan- 
gering a wide-spread mortification or a considerable ulcera- 
tion. In such cases, it is best to dress the wound itself with 
a mild or gently stimulating ointment, such as simple cerate or 



260 or CONTUSIONS. 

basilicon, (see Index, Salves.) leaving the neighbouring surface 
free for the application of other remedies which its condition 
may require. When the mortification of the edges threatens 
to be extensive, when the constitution of the patient is feeble, 
and there is danger of a progressive gangrene, the stimulating 
poultices, such as the yeast poultice, become valuable reme- 
dies. 

Poultices should not be employed too long in the treatment 
of contused wounds; for, after the granulations have been once 
fully formed, they are extremely apt to become flabby or form 
proud flesh, if kept too moist and warm by the dressing?. 
When a contused wound is long in healing it is proper to con- 
sider and treat it as an ulcer, and we will refer to the section 
on ulcers for further particulars. If proud flesh should make 
its appearance, it may be repressed by the means prescribed 
under the last head. 

Or Contusions. A contusion or bruise is an internal wound 
or rupture. It needs no external dressings to protect it from 
the action of the air, for it is always covered by the skin, if 
not by other tissues. When a contusion recovers in the sim- 
plest way, the blood which is always poured out from some of 
the smaller blood-vessels, is gradually changed in colour, from 
the dark purple or black of the fresh coagulation, through the 
tints of blue, green, yellow and brown, so well known to all. 
These changes result from the action of the absorbents, which 
take up the colouring matter of the blood more rapidly than 
the solid parts. As the coagulum disappears by absorption, 
the torn parts again come into contact and unite; but as the 
serum of the blood is always separated during the act of co- 
agulation, this serum, carrying with it a portion of colouring 
matter, flows out and spreads in the surrounding cellular tis- 
sue; often settling by its weight into parts at some distance 
from the seat of the injury; as we see in the lower evelid after 
bruises on the forehead. The serum is often more slowly ab- 
sorbed than the solid coagulum, so that we frequentl v observe a 
ring of many colours round a bruise which has apparentlv re- 
covered: but I have never known the serum to give rise to 
any material trouble. 

When the quantity of blood effused is much more conside- 
rable, and the part in which it is contained is profoundly in- 
jured by the accident, or when the constitution of the patient 
is in bad condition, the coagulum sometimes degenerates or 
becomes putrid before the debilitated absorbents can remove 
it. This leads to the formation of an abscess which, when it 
bursts or is opened, often gives rise to an ill-conditioned ulcer, 
difficult to cure. As a general rule, when a considerable n 
of blood is poured out near the surface of the body, and after 



OV CONTUSIONS. 261 

remaining hard, like a firm coagulum,for a considerable time, 
becomes quite soft and fluid, so as to convince us that it has 
been dissolved — it is best to open and evacuate the cavity 
by passing a thumb lancet very obliquely into it: the attempt 
may then be made to close the orifice by an adhesive strip, 
and the whole cavity by a compress of lint and a light ban- 
dage; but if, as generally happens, inflammation appears ©r is 
increased after the dressing, it must be immediately removed, 
a proper poultice substituted, and the treatment managed as 
in other cases of abscess. (See Index.) Collections of blood im- 
mediately beneath the cuticle, occasioned by bruises, are usu- 
ally termed blood-blisters. In these the effused fluid generally 
remains fluid or very soon becomes altered, probably by the 
action of the air through the very thin pellicle which covers 
them. They scarcely ever disappear by absorption, though 
seated directly on one of the most powerful absorbing surfaces 
in the body; and if they are opened directly, they become ex- 
tremely painful and produce severe inflammation or ulcera- 
tion. It is best to allow blood-blisters to remain untouched 
for several days, after which their contents may be evacuated 
by passing a pin or needle for some distance under the neigh- 
bouring cuticle before permitting it to enter the blister. In 
this way the free admission of air is prevented, and the pain 
and irritation avoided. 

When the quantity of blood effused in a contusion is very 
great, a curious result often follows, which is apt to produce 
great alarm in the patient and his friends. The air which al- 
ways escapes from blood as it contracts after coagulation, is 
forced out in such quantities as to distend the cellular tissue 
for some distance around the seat of the injury. The part 
then crackles under the pressure of the finger, and as the dark 
colour often strengthens the deception, it is supposed that gan- 
grene or mortification is about to take place. 

Though the presence of this air endangers the decomposi- 
tion of the blood, which would inevitably occasion a seri- 
ous or destructive abscess, yet it is often absorbed without dif- 
ficulty in a few days, leaving the coagulum to be removed 
more slowly; and the patient then recovers, sometimes with 
very few troublesome symptoms, even when the appearances 
are, at first, very much against him. 

Another cause of alarm in severe and extensive bruises, is the 
appearance, over the injured surface, of small blisters filled with 
a bloody serum, precisely similar to those which are so often ob- 
served when an inflammation is on the point of ending in mor- 
tification. But when these collections precede, instead of fol- 
lowing the commencement of inflammation, they are not a very 



262 CONTUSIONS IN CAVITIES. 

certain indication of danger, although they prove the injury 
to be both deep and severe. 

In very severe bruises, when the patient is thrown into col- 
lapse by the accident, it is sometimes adviseable to bring on a 
re-action by giving the patient a glass of wine, or some other 
gentle stimulant; but the use of the lancet, which is almost al- 
ways recommended by the ignorant under such circumstances, 
is extremely improper, and occasions the death or the sacri- 
fice of the constitutions of many. Except in some cases of 
injuries of the head, no one should be bled after a severe acci- 
dent until the pulse has risen and fever is about to appear. 
Then, indeed, it is often proper to bleed freely and fearlessly. 

When the inflammation which usually follows a bruise has 
passed away, leaving the parts in a condition so debilitated 
that the absorbents are unable to take up the remains of the 
effused blood and serum, we may often accelerate recovery by 
bathing or dressing the part with some stimulating application, 
such as diluted brandy, spirit of hartshorn, camphor, &c. 

When bruises occur in parts remarkable for the number 
and development of the nerves of sensation, such as the ends 
of the fingers and toes, the pain produced by the accident is 
very severe, and often intolerable. It is right in these cases 
to dress the contusion with rags or a very loose bandage com- 
pletely wet with laudanum; or if the contusion be too exten- 
sive for this mode of treatment, a milk-warm poultice of hops 
and vinegar should be applied. When the pain in these ner- 
vous parts results from inflammation, which often comes on 
some hours or days after the accident, the treatment must be 
different. Laudanum is then too stimulating, but the solution 
of opium in water may be mixed with the plain bread and 
milk poultice which forms the best local application. In 
bruises and crushes of the fingers and toes, the distressing 
wakefulness occasioned by this inflammatory pain may be re- 
lieved at once by a dose of antimonial wine, just sufficient to 
produce nausea without vomiting. Laudanum, even when 
given internally, increases the severity of the complaint. 

Contusions in the great cavities of the body are more com- 
plex and dangerous in their nature than those which are located 
on the extremities: they are also much more difficult to distin- 
guish and comprehend. 

There are two distinct modes in which contusions may oc- 
cur in the viscera of the great cavities. 1st. The pressure or 
blow of an external body may crush the bony walls or com- 
press the flexible covering of a cavity in Mich a manner as to 
injure the viscera or bowels which it contains: or, 2nd. In 
falls from a height, when the body is suddenly arrested, the 
larger and heavier viscera, such as the liver, spleen, brair 



INJURIES OF THE HEAD. 263 

experience a violent jolt, and may be most severely bruised, 
or even torn from their connexions by their own weight, (mo- 
mentum,) so as to occasion death without any signs of exter- 
nal injury. 

Severe contusions of the great cavities are much more seri- 
ous in their consequences than similar injuries occurring ex- 
ternally; because the free action of the organs enclosed in these 
cavities is necessary to life. A blow which temporarily disa- 
bles a voluntary muscle produces little mischief, because the 
patient may very well remain at rest until the muscle gradu- 
ally recovers its power; but when the function (the peculiar 
power of action) of any important internal organ is arrested in 
consequence of the application of a mechanical force, death 
often follows long before sufficient time has been allowed for 
the organ to recover its tone. 

After these remarks the reader will be able to perceive the 
necessity of a few comments upon contusions of each of the 
great cavities. 

Of Injuries of the Head. External contusions of the scalp, 
when unaccompanied by open wounds, are not of much im- 
portance, except sometimes in children. In early life, it oc- 
casionally happens that blood iseffused immediately under the 
skin of the scalp, and when the cavity which contains it is 
opened either by nature or art, the part becomes the seat of 
a small abscess which proves very difficult to treat. The best 
practice in such cases is to lay open the whole cavity by two or 
more free incisions, apply a bread and milk poultice, and leave 
the abscess to fill itself with granulations from the bottom. A 
neglect of this course sometimes occasions troublesome or even 
dangerous disease of the bones. 

The special importance of contusions of the head results 
mainly from the injuries sustained by the brain or principal 
nerves. These vary in degree and character, so as to demand 
especial notice. 

One of the most simple and common injuries of the head 
results from the unwarrantable and cruel practice of boxing 
the ears, as a punishment for children. Its consequences are 
often distressing in the highest degree, and not unfrequently 
prove fatal to the intellect or life of the sufferer. Even when 
the blows are lightly struck, the air is forced with great vio- 
lence upon the drum of the ear, and when that membrane 
escapes a rupture destructive to hearing, — an accident which has 
repeatedly happened! — the delicate, and exquisitely suscepti- 
ble nerves of the interior of the ear are compressed to such 
a degree as to give rise to terrible irritation of their other ex- 
tremities in the brain. Severe headach is the lightest of the 
evil consequences of this savage treatment, and, if the punish- 



264 INJURIES OF THE HEAD. 

ment be frequently inflicted, fatuity or extreme dulness of 
mind and temper are a very common result! But even these 
are trifling, in comparison with other effects by no means in- 
frequent. Epilepsy, inflammation of the brain, and sudden 
death, may and do follow such inflictions, and it is not always 
that the author of the cruelty becomes aware of his or her own 
agency in the business; for the fatal affections but rarely ap- 
pear until some weeks or even months have elapsed. If the 
argument of brute force be really necessary, which, in well re- 
gulated families is very seldom the case, for the love of mercy 
and humanity let it be the argumentum a posteriori! 

The next accident in violence which claims attention is sim- 
ple concussion of the brain, or stunning. When the head is 
forcibly struck or suddenly arrested in a fall, the weight of the 
brain causes it to press forcibly against that side of the scull 
which receives the blow; and an injury more or less severe 
results from the violent but momentary compression of this 
most important organ. In the mildest form of the accident, 
the jar produces a peculiar bewilderment of mind, followed 
almost instantly by a sensation of terror, which passes off in a 
few moments, leaving the patient in health. Concussion, in 
this degree, scarce ever gives rise to any important conse- 
quences, and is generally even less dangerous than a smart box 
on the ear. Hence, in the falls of young children, if the child 
cry freely at the moment of the blow, or very soon after- 
wards, we may generally regard the accident as unattended 
with danger. 

When the blow is somewhat more severe, all consciousness 
is lost; the surface of the body becomes pale, a general col- 
lapse is produced, and it is some time before the patient reco- 
vers the command of his senses. If the pupil of the eve be 
examined at this time, it will be found in a large majority of 
cases either of its natural size or somewhat enlarged, but very 
slightly susceptible of the action of light; that is, it does not 
dilate and contract freely when the lids are alternately closed 
and opened again. 

The limbs are generally found completely relaxed in sim- 
ple concussions which are not very severe, but in more grave 
accidents of this class they are often found in a state of spas- 
modic stiffness, and the pupil may then appear considerably 
contracted. 

This last condition is more threatening, for it proves that 
the jar has been strongly felt at the origin of the nerves and 
the attachment of the spinal marrow, while the contraction of 
the pupil shows the existence of a local irritation coupled with 
the weakness produced by the shock. 

When a patient is recovering from an accident of this cha- 



OF CONCUSSION OF THE BRAIN. Z&5 

?acter he usually complains of considerable nausea, and dis- 
tressing vomiting is a common symptom in bad cases. 

In a few minutes or hours, the symptoms of collapse gradu- 
ally wear ofl', leaving in most instances no trace of the injury, 
other than a general feeling of weakness, lassitude of mind, 
and perhaps a head-ache more or less severe. Fever some- 
times, but rarely appears with the approach of reaction. But 
the dangers which follow a concussion are by no means con- 
fined to the few days immediately succeeding the accident. 
There is always more or less danger of inflammation of the 
substance of the brain from the irritation produced by the 
shock, and this most dangerous affection makes its approach 
very slowly and insidiously. The first symptom which usu- 
ally marks its approach is a dull, deep-seated, heavy pain in 
the head, succeeded by a slight chill or repeated rigors, which 
soon give rise to an obscure feverishness and a marked tenden- 
cy of blood to the head, first observed from one to two weeks 
after the accident. If the progress of the disease be not 
checked by vigorous treatment, the patient soon begins to dis- 
play a sluggishness of speech and ideas, with an increasing 
disposition to sleep; but Jittle pain is experienced, because the 
substance of the brain, though the judge of all sensations, pos- 
sesses, in itself, no sensibility whatever. After a time the 
sleep, or rather, drowsiness of the patient is disturbed by low 
muttering delirium; and when abscess of the brain results, the 
commencement of this stage of the complaint is marked in 
most cases by a peculiar form of convulsion. The patient 
starts up suddenly in bed; his countenance expresses great 
anxiety and distress, he turns his head, tosses his arms wild- 
ly about for a few moments, and then sinks back on his pil- 
low. These paroxysms are repeated perhaps every two or 
three hours, but are not attended by a total loss of conscious- 
ness. I have never known a case of recovery after this form 
of convulsion appeared. The patient soon sinks into stupor, 
and dies in three or four days at farthest. 

The treatment of concussion of the brain is simple and 
obvious. In the mildest form of the accident, a few hours' rest 
and a few days of moderate caution against errors of diet and 
excitement of mind will render the patient secure from dan- 
ger. 

In the cases marked by temporary loss of consciousness, 
more care is necessary, and when vomiting occurs the utmost 
attention should be paid to the condition of the patient. No- 
thing can be done with safety by unprofessional attendants 
until consciousness returns, and bleeding during the first mo- 
ments of the shock would be utter madness in simple concus- 
sion. As the senses return, the sickness of stomach may be 

34 



266 TREATMENT OF CONCUSSION. 

checked, if necessary, by giving a little peppermint, or by a 
wine-glassful of a strong infusion of Horsemint, (monarda 
punctata) made with boiling water in an earthen vessel, and 
then suffered to cool, or by the application of a spice plaster* to 
the pit of the stomach. 

The patient should be confined to his bed, in a darkened 
room. His mind should be kept free from all excitement. All 
loud sounds, and every thing calculated to excite his senses 
should be prevented, and all persons but his necessary attend- 
ants and nearest female relations excluded. This caution 
should be continued until the patient has recovered entirely 
from the apparent effects of the blow, which in grave acci- 
dents may be protracted for several days. 

Costiveness is a common symptom in severe concussions, 
and it is proper to remove it by active purging; for the coun- 
ter-irritation produced by such measures, tends to relieve the 
head from direct irritation. If no professional assistance can 
be procured, the following prescription may be hazarded — 
Take of Powdered Rhubarb 8 grains. 
Powdered Aloes 2 grains. 

Calomel 4 grains. 

Mix these with a few drops of water, and make the mass 
into four pills, of which two may be given immediately, and 
the remainder in two hours. 

When the urgency of the case requires it, this treatment 
may be repeated for two or three days in succession; but for 
delicate females the dose must be diminished to one half. 

If fever should come on upon the appearance of reaction, it 
is proper to abstract a little blood from the arm, and to use 
cooling drinks, and a gentle saline purgative, such as Epsom 
salts in divided doses; or the Seidlitz powder. 

The diet of a patient who has suffered under a concussion of the 
brain should be quite low for the first few days, and it is import- 
ant that all irregularities or excess be carefully avoided for two 
or three weeks; for until the lapse of that interval, there is al- 
ways some danger of an excess of inflammation of the brain: 
and this danger is much increased by the indulgence of the 
appetite. 

Inflammation of the membranes of the brain is a very rare 
consequence of the class of accidents of which we are speak- 
ing. When it does occur, it is marked by violent fever and a 
phrensied delirium, very different from that which characterizes 

♦ Take of cloves and cinnamon, passed through a coffee mill, of each a heap- 
ing tea spoonful; of black pepper about the half of that quantity. Mix these, and 
and an equal quantity of flour. Make the mixture into a paste with brandy or 
whisky; spread it upon a piece of muslin 8 inches square, and lay it on the pit 
of the stomach. 



OF COMPRESSION OF THE BRAIN. 267 

the inflammation of the substance of the brain. The appro- 
priate treatment will be found under the proper head in the 
medical portion of this work. 

Of Compression of the Br ain. Next in point of importance 
to the simple concussion of the brain, comes the accident 
usually termed compression of the brain. 

This is always the result of a contused wound of the sub- 
stance of the organ, and may occur from either of these causes: 
1st, The rupture of a blood vessel from over distention, which 
causes Apoplexy or Palsy, subjects discussed in the medical de- 
partment of this work. 2nd. Fracture of the skull, which pro- 
duces this result only in certain instances, and will be, therefore, 
considered in the sequel of this article. 3d. Falls or blows, in 
which the brain is compressed against its bony case with such 
force as not only to bruise, but even to tear its substance, in 
such a manner as to cause bleeding from one or more blood 
vessels of considerable size. In this case, the blood, having no 
means of egress from the bony cavity which contains the brain, 
necessarily presses upon its substance more and more, as it is 
forced out of the vessels by the power of the heart and arte- 
ries. 

Our present remarks refer to accidents of the third class, 
chiefly. 

The collapse of the system which is produced by an injury 
as serious as that of which we are speaking, always diminishes 
the force of the circulation, and generally, but not always, 
prevents the rapid effusion of the blood over the brain. The 
first symptoms in most cases are therefore those of simple con- 
cussion, and the signs of compression appear, and go on rapid- 
ly increasing after the patient has showed some signs of re- 
turning consciousness. When the ruptured blood vessels pour 
out their contents freely from the first, the marks of compres- 
sion and concussion are so confused that it is often impossible 
for the most practised surgeon to pronounce upon the real na- 
ture of the case, and the treatment being equally difficult, it 
would be folly to pursue the subject here. 

The peculiar marks of compression are the strong dilatation 
of the pupil, and a deep stertorous or snoring respiration, to- 
gether with a partial or total loss of consciousness, and a par- 
tial or complete inability to move the limbs. In the simplest 
cases, the muscles are perfectly relaxed or palsied, spasms ap- 
pearing only when the injury has produced an irritation of 
some or all of the nerves of motion. In a few words, the patient 
appears apoplectic. 

When a patient subjected to a severe fall or blow upon the 
head, has laboured for some time under the symptoms of con- 



26S FRACTURES OP THE SKULL. 

cussion as already described, — when he has afterwards reco- 
vered his consciousness in part, or completely, and the signs 
just mentioned as characteristic of compression begin decidedly 
to approach (particularly if the colour of the face be height- 
ened,) the nature of the case cannot be considered doubtful. 

Under such circumstances the treatment required is very 
obvious. The returning energy of the circulation must be 
kept down by the lancet, and all obvious re-action rendered 
impossible by the loss of blood. Physicians of skill, and those 
only, can venture upon bleeding in those still more alarming 
cases in which there is reason to suspect an active hemorrhage 
in the brain, while the system still labours in profound col- 
lapse. These are the exceptions of cases to which we have for- 
merly alluded, as warranting the use of the lancet almost im- 
mediately after a severe accident. 

The recovery in cases of compression without fracture is 
slow and tedious. The patient, in a large majority of cases, 
remains subject for a long time to symptoms of palsy, and the 
loss of power is sometimes rendered permanent. 

It is unnecessary to dwell any longer upon the general treat- 
ment of compression, for, as it is always attended with more 
or less concussion and contusion of the brain, the danger of 
subsequent inflammation and abscess are as great as in the ac- 
cidents previously described, and in addition to the early use 
of the lancet, the other remedies and precautions mentioned 
under the previous head must be employed. 

Of Fractures of the Skull. A simple fracture of the 
skull unattended with depression, concussion or compression 
of the brain, is not always an accident of much importance. 
The broken edges in such cases cannot be dragged out of their 
proper position by the muscles attached to them, but lay quietly 
in their places, and the wound requires no peculiar treatment, 
recovering as readily as a flesh wound, only that it requires a 
little more time. It is therefore usual among surgeons to con- 
sider fractures of the skull, not among fractures in general, but 
in connexion with Injuries of the Brain. 

There are two accidents occasionally resulting from very 
simple fractures of the skull which do not directly involve the 
brain; the one, fatal — the other, highly dangerous. 

The first of these is seen when the crevice or fissure runs 
across the track of some tolerably large blood vessel enclosed 
entirely within the bone, when this vessel is torn, and when 
the blood, finding no free passage externally, flows within the 
cranium and produces compression of the brain. 

This accident is most frequent in fractures from blows on 



FHACTURES OF THE SKULL. 269 

the temple, — when the middle artery of the dura mater or in- 
ternal periosteum of the head is apt to be torn, — and in frac- 
tures of the base of the skull, from smart falls on the feet with 
the knees in the extended position — when there is danger of 
rupturing the jugular vein, as it enters the cavity of the head 
through a hole in the bone toward which the fissure in most 
cases directs itself. 

The treatment in such cases is obvious. If symptoms of 
compression come on gradually after a blow on the head, and 
the route of a fracture can be ascertained by the finger, espe- 
cially if it pass toward the front of the temple, we should make 
a free incision down to the bone, with a knife, as nearly as 
may be across that part of the track which corresponds with 
the pi incipal blood vessel known to be enclosed in the bone on 
that part of the head which is the seat of the injury. In this 
manner we may sometimes save life by giving an outlet to the 
accumulating blood. Surgeons may do much more in some 
cases, for they may apply the trephine, and after removing a por- 
tion of the bone, may remove part of the blood already effused, 
and, if necessary, plug the artery. This treatment is of course 
inapplicable when the jugular vein is injured, for this vessel 
lies far beyond the reach of the knife. 

The second accident to which we have alluded, is the oc- 
currence of Epilepsy from the following cause: — 

When a narrow fracture of the skull unites, the bond of union 
is generally bony; and in this case it is always irregular, oc- 
cupying more space than the healthy bone. This tumour 
causes a slight pressure on the brain within, and becomes a 
source of slow or chronic irritation, accompanied by a deter- 
mination of blood to the head whenever the patient labours 
under unusual bodily or mental excitement. This often pro- 
duces an Epilepsy, the attacks of which complaint may be ren- 
dered less frequent, but cannot be cured by the general regu- 
lation of diet and medicine laid down in the Medical Depart- 
ment of this work. A severe and dangerous operation has 
been practised for the relief of such cases, and, in some in- 
stances, with success. A portion of the bone over the origi- 
nal fracture, and including the tumour, has been removed by 
the trephine. The loss of so large a piece of the skull prevents 
the orifice from being again closed by bone; but a strong 
fibrous membrane is formed in its place; and, being flexible, 
this prevents the brain from suffering by pressure. 

The dangers of this operation are so great, and the number 
of cases in which it has yet been tried, so small, that its pro- 
priety under any circumstances is still considered question- 
able. 

Fractures of the skull attended by depression are gene- 



270 FRACTURES OF THE SKULL. 

rally productive of the most serious consequences; but the 
rule is not without its exceptions. 

'At the time of birth, or in the earlier years of infancy, it is 
not very uncommon for children to meet with accidents such 
as are now under consideration. A portion of the skull may 
be deeply indented, and symptoms of compression of the 
brain may or may not be presented; but the bones being but 
partially ossified, and not completely connected together at 
their edges, the fragments are soon raised nearly to their na- 
tural position by the pulsations of the brain, and the head, as 
ossification advances takes a form accommodated to the slight 
change of position in its contents. It is seldom necessary to 
do more than put the child upon a slender supply of milk 
gruel or panada, (according to its age,) to keep the bowels 
open, to apply gentle cold to the head, and to avoid all ex- 
posures and causes of excitement; such as light, loud talking, 
dandling, and rocking in the cradle, for two or three days. 
If surgical aid be required, none but the most able assistance 
can be of any advantage. 

When similar accidents occur in grown children, or adults, 
if the amount of depression be slight, no symptoms of com- 
pression may appear, and it has been decided pretty generally 
among surgeons, that under such circumstances it is improper 
to cut down upon the bone, or to attempt to remove any frag- 
ment by the trephine, because, by so doing, we convert a sim- 
ple into a compound fracture. We think that the propriety 
of this rule depends on the form of fracture. There are many 
cases of this kind in which the trephine ought to be applied, 
but it is unnecessary to point them out in a popular work. 
If the accident itself has produced a wound which lays bare 
the fracture, then, indeed, it is always proper to extend the 
cut, if necessary, in order fully to determine the nature of the 
case. 

Fractures of the skull occurring to adults or well grown 
children, when attended with depression, but not with alarm- 
ing symptoms, if they be left to nature, too frequently occa- 
sion subsequent epilepsy, or severe nervous disorders, which 
render life a burden. 

In fractures with depression attended with serious symp- 
toms, the effects produced are precisely the same with those 
already described under the head of depression — except that 
they reach their height, in most cases, at the moment of the 
accident, instead of coming on gradually, as they do in c 
of pressure from hemorrhage. The cause being the diminu- 
tion of the size of the cavity containing the brain by the crush- 
ing in of its solid walls, the effect can be removed only by re- 
storing or raising these walls to their proper place by means 



OF CONTUSIONS IN THE CAVITY OF THE SPINE. 271 

of a metallic lever; and in order to give this lever an entrance 
beneath the edge of the depressed fragments, it is generally- 
necessary to cut out a piece, often from the sound part of the 
skull, by means of a peculiar circular saw. This constitutes 
what is commonly called the operation of trepanning. Of 
course, the whole subject is strictly professional, and is intro- 
duced in this popular work merely to gratify the curiosity of 
the reader. 

When fracture of the skull is complicated with a rupture of 
the membranes of the brain, or a loss of part of its substance, 
the danger is always very imminent; but it is a mistaken no- 
tion that such cases are inevitably mortal. It is never too 
late to apply to high surgical authority in injuries of the 
head. 

The treatment of these accidents is rendered more difficult 
and complex by the infinite varieties in the form and position 
of the fragments, which in addition to simple compression 
sometimes give rise to internal bleeding, or wounds and con- 
tusions of the substance of the brain, and sometimes to mere 
irritation of the membranes, from the irregularities of surface 
presented by the fracture. It would be impossible to give 
the popular reader any idea of the mode of distinguishing 
these complications, or the remedies for their relief. The 
whole subject is one of extreme difficulty, and with the few 
remarks here given, we will close our observations on injuries 
of the head. 

Of Contusions in the Cavity of the Spine. Though 
small, the cavity of the spine is of the utmost importance, in 
consequence of the nature of its contents. The spinal mar- 
row and the origins of nearly all great nerves of sensation and 
motion are located within it. It is liable, like the head, to a 
variety of accidents producing concussion, compression, and ir- 
ritation of its contents. The thickness and loose texture of the 
vertebrae or bones of the spine, and their mobility upon each 
other, render them less liable to injury from falls and blows, 
and they are additionally protected by the thick and strong- 
muscles which surround them; but this immunity is partly 
compensated by their liability to sprains and dislocations, in 
consequence of the number of regular joints formed between 
them. 

Injuries of the spine are scarcely less important than those 
of the brain, and a wound or severe contusion of the spinal 
marrow almost always ends sooner or later, in death. 

Fractures of the Transverse and Spinous Procession or 
projecting parts of the vertebrae, sometimes occur without any 
serious injury, and all that is necessary in the treatment of 
such cases is to keep the patient in the most comfortable atti- 



272 "FRACTURES OF THE BODIES, &C. 

tude for four or five weeks, and to employ the usual measures 
to prevent or reduce inflammation in the commencement of 
the case, (see Inflammation) and to pursue the regimen 
proper in fractures generally, at a later period (see Frac- 
tures.) When the muscles attached to the broken processes 
do not of themselves preserve the fragments in a proper posi- 
tion, no mechanical measures can accomplish the purpose, be- 
cause the fragments are too deeply embedded in the flesh to 
be acted on by such means, and they, therefore, unite in an 
unnatural or deformed position; but this is rarely a matter of 
much consequence. 

Fractures of the Bodies, or Lateral Arches of the Vertc- 
brae, and sudden Dislocations, almost inevitably occasion 
permanent compression of the spinal marrow or principal 
nerves. In all such cases the parts of the body below the 
seat of the injury are incurably palsied, and there is scarcely a 
shadow of chance for the life of the patient. If the injury be 
located low down in the lumbar region, life may be protract- 
ed for some months — if in the middle of the dorsal region, 
several weeks may elapse before the fatal termination — if in 
the lower part of the neck — the period is limited to a few 
hours or days; but when the dislocation or fracture occurs 
near the upper extremity of the neck, the death of the patient 
follows in a manner nearly or absolutely instantaneous, pre- 
cisely as an animal dies who has been pithed. 

The reason of the variety in the time of death from inju- 
ries of the spine is this. The numerous connexions between 
the great nerves of motion and sensation which originate from 
the spine in the manner described in the anatomical part of 
this work, are connected by a regular series of branches with 
the sympathetic system and the nerves of organic life — any 
injury, therefore, which seriously impairs the integrity of the 
spinal marrow, produces a powerful impression upon the vital 
powers of the internal organs, and as the most important of 
the vital organs are seated high up in the body, while the 
palsy and disturbance from injuries of the spine is confined to 
parts below the injury, it follows that the higher the seat of 
the mischief, the more speedy is the death. 

It is altogether useless to give any information on the sub- 
ject of the local treatment of fractures of the body or lateral 
arches of the spine. Some very severe surgical operations 
may be occasionally warranted for the relief of these accidents, 
but the friends, nurses, or assistants can do little beyond 
placing the patient at perfect rest in a convenient attitude. 
One precaution may, indeed, prolong the life of a patient. It 
will be mentioned under the head of concussions of the spine. 

Contusions of the Muscles and other soft parts about the 



CONCUSSIONS OP THE SPINE. 273 

Spine, and Sprains of the Vertebrae, which latter are proper 
contusions of the ligaments of the articulations, are treated on 
pretty much the same principles with similar injuries of other 
parts. They are, however, peculiarly prone to produce se- 
vere and long continued pain resembling rheumatism, which 
it is extremely difficult to remove. After the immediate ap- 
plication of cold or warm ablutions to the part, according to 
the constitution and sensations of the patient, if inflammation 
runs high, the diet should be vigorous, and leeches should be 
very freely applied. When the inflammation disappears, sti- 
mulating embrocations, such as the soap or volatile linaments 
(see Index,) are often highly useful. The best mode of re- 
lieving the chronic pains, which often continue for months or 
years, is by the application of plaster of Burgundy pitch, or 
hemlock, or, what is far better when obtainable, the sheet India 
rubber bound over the part for several weeks together. During 
the whole inflammatory stage, and for some time after, the 
strictest rest must be maintained, and strong muscular efforts, 
particularly in lifting, should be prohibited until all traces of 
the injury have disappeared. 

Concussions of the Spine from falls or blows, generally 
produce great weakness, and sometimes complete paralysis of 
the parts below the seat of the injury. These effects are, for 
the most part, evanescent, and require no other treatment than 
rest. 

A few hours would usually be sufficient to restore the pa- 
tient, were it not that the bladder very often becomes para- 
lyzed at first, and it then offers no effective resistance to the 
accumulation of urine, which it has no power to discharge, if 
not prevented by artificial means. The distention goes on in- 
creasing until the fibres of the organ are stretched beyond the 
point at which they lose their power of contraction, even 
after the nervous energy returns; and if this state of things be 
permitted to continue, the bladder will burst and the patient 
must die. It is highly necessary, then, that the condition of 
the urinary discharge should be narrowly watched, and as 
often as twelve hours pass without an evacuation, the catheter 
must be introduced. This is the more necessary as the blad- 
der is benumbed by the concussion, and does not become the 
seat of pain or much uneasiness; so that, in many cases, if the 
surgeon do not inquire into its condition, the patient may 
not become aware of the difficulty until after the organ is 
ruptured! By applying the catheter twice a-day for three or 
four days, we commonly succeed in restoring the tone of the 
bladder. 

There is one circumstance, in connexion with this matter, 
which deserves especial attention. It sometimes happens that, 

35 



274 OF CONTUSIONS IN THE CHEST. 

the bladder, after being distended to a degree which com- 
pletely paralyzes it, discharges a portion of urine from time 
to time, by the mere pressure of the abdominal muscles. This 
may deceive the friends of the patient and lead to fatal ne- 
glect. In such cases, the abdomen will be found swollen and 
tense, with a hard, rounded, internal tumour extending from 
the brim of the pelvis nearly or quite to the navel, which 
does not disappear even after the imperfect discharges just 
mentioned. Unless this condition be relieved by the cathe- 
ter, the bladder may be rendered incapable of recovering its 
tone for months, or even permanently, and incontinence of 
urine is the terrible result. 

This affection of the bladder occurs also in most cases of 
fracture or dislocation of the spine, and the same effects are 
produced upon the rectum; or, if the injury be high up upon 
the back, the whole of the intestines are rerrdered torpid or 
paralytic. These results, (incurable in cases of fracture or 
sudden dislocation) are among the most important causes of 
death in injuries of the spine below the middle of the back. 
It is hardly necessary to dilate any farther upon the treat- 
ment in a popular work; for the aid of the surgeon will al- 
ways be sought when obtainable, and we have said all that can 
be trusted with safety in the hands of the uninitiated. 

Of Contusions in the Chest. The bony frame of the chest 
is at the same time so strong and so elastic, that internal con- 
tusions from falls and blows are much more rare than might 
be supposed. The lightness and mobility of all the organs in 
this cavity except the heart, together with the peculiar elastic 
membranous supports, the flexible floor of the diaphragm, and 
the bed of air furnished by the lungs to the latter viscus — all 
tend to protect the chest against the consequences of violence. 
Yet there are many causes which do occasion contusions with- 
in the chest, a severe blow directly over the heart might possi- 
bly produce a bruise of that organ, and a similar impression 
on the sternum or breast bone has been known to give rise to 
an abscess within the front of the chest. 

But contusions of the interior of the chest are rarely caused 
by any other accidents than dislocations or fractures of the 
ribs or their cartilages. When the fragments in such cases 
are driven inward, the pleura first, and then the lungs are apt 
to suffer. 

We have already spoken of wounds of the lungs, such as 
result from their puncture by a sharp, projecting portion of a 
broken rib, (see Wounds of the Chest.) The milder injuries 
occasioned by an angular projection, or an overlapping of the 
fragments are seldom extensive, because the lungs yield so 
readily to pressure. 



OP CONTUSIONS IN THE ABDOMEN. 275 

But the great danger in all cases of contusions of the chest 
is active inflammation, either of the pleura or the lungs. The 
former kind of inflammation, when confined entirely to the 
serous membrane, rarely occasions much pain; while in the 
latter, the suffering is often intense: but these two affections 
are generally confused together by unprofessional persons, and 
often by medical men themselves. Both, when severe, are 
attended with high fever, and independently of the treatment 
of the fracture or dislocation, from which they may have 
arisen, their treatment consists chiefly in repose, rigorous diet, 
the avoidance of all stimuli, perfect quietude, and the free use 
of the lancet, when the constitution of the patient will warrant 
it. The various organs of the chest being seated close to the 
centre of circulation, and provided with innumerable blood 
vessels of unusual size, their inflammation from mechanical 
injuries require more active depletion than those of almost 
any other part of the body. 

A very powerful remedy in lessening inflammation of the 
chest, is the tartar emetic, given in divided doses, so as to pro- 
duce decided sickness or nausea; but the history of the inter- 
nal treatment of this affection belongs, more properly, to the 
medical department of this work, where it will be found under 
the headsof pleurisy and inflammationof thelungs. Cold drinks, 
such as ice water or lemonade, in small quantities, are highly 
useful; but the external application of cold water, so useful in 
many forms of inflammation, is generally improper, because 
it tends to drive the blood inward toward the seat of the in- 
jury. When fever runs high, cold applications to the fore- 
head, face, wrists, and ankles are useful, and are much more 
safe in inflammations of the chest produced by contusions, 
than in those which arise from internal causes. 

Of Contusions in the Abdomen. Of the very large, im- 
portant, and heavy organs contained in the abdomen, many 
are liable to severe contusion or even laceration from internal 
forces which leave no mark on the soft and flexible walls of 
this cavity. These accidents are generally fatal, though re- 
coveries sometimes take place even under the most unfavour- 
able circumstances. 

All such accidents produce most serious depression of the 
system, and the patient rarely recovers from the collapse. 
When reaction comes on, the case becomes one of a purely 
internal character, and the treatment being medical rather 
than surgical, the reader is referred for information on the 
subject to the appropriate heads in the medical portion of this 
work. The immediate effects of these accidents are all that 
interest us here. 

The Liver and Spleen are suspended upon strong liga- 



27G OP CONTUSIONS OF THE LIVER, &C. 

mentous or membranous connexions, which cannot yield to any 
considerable extent. Their weight is so great that their sub- 
stance may be crushed, or they may be torn in part from their 
connexions, by their own acquired momentum or descending 
force, when the body is suddenly arrested in falls from a great 
height. The liver may be torn or contused by a blow which 
strongly compresses the walls of the abdomen near the short 
ribs, and bends the edge of the liver upon itself. The spleen 
itself is not altogether beyond the reach of a blow on the 
loins. 

The first and greatest danger of these accidents is internal 
hemorrhage, the next, inflammation and abscess. The col- 
lapse is always profound, and as it is extremely difficult, if 
not impossible to determine precisely the nature or extent of 
the accident, the only direction which can be given to the un- 
professional attendant, is to place the patient fn a state of re- 
pose, and trust solely to the powers of nature, until reaction 
occurs, when the case must be treated with decision and firm- 
ness, in the manner prescribed for inflammations and abscess 
of the liver, in the medical portion of this work. 

The Kidneys are very rarely contused by blows; but in- 
stances have occurred in which they have been bruised and 
even ruptured, by blows on the loins from falls, or received 
in fighting. In such cases, the treatment required is similar 
to that prescribed under the head of Nephritia or Inflamma- 
tion of the Kidney, in the medical department. The nature 
of the mischief is easily determined by the severe and pecu- 
liar pain felt in the small of the back, which is only relieved 
by rendering the back perfectly straight, or by bowing the 
body very far forward. 

It is not uncommon for the kidney to suffer severely in 
those terrible accidents, which happen so frequently from the 
caving in of banks of earth; but the mischief done to the ab- 
domen in general, in these cases, often renders the injury of 
the kidney a matter of secondary importance. 

Bloivs on or near the Stomach often produce instantaneous 
death, probably by the injury done to some of the most im- 
portant portions of the nervous system «f organic life. 

Blows received lower down upon the Abdomen are strong- 
ly resisted by the abdominal muscles; and the plastic:' 
semifluidity of the great mass of intestines with their con- 
tents, tends to neutralize the effect of the force, bv distributing 
it equally over the whole cavity. Injuries from such cause's 
are, therefore, less serious than might be expected, unless the 
force applied be very violent, as in kicks from horses, and in 
partial inhumation under falling banks. 

All serious contusions of the abdomen are attended with ex- 



OP BLOWS ON THE ABDOMEN. 277 

treme depression. The pulse, if perceptible, is small, weak, and 
generally frequent; the countenance pale and dejected, with a 
peculiar expression of pain about the face; and it is remarkable 
that these symptoms of collapse may be attended with active 
and severe inflammation of the whole cavity of the peritone- 
um, which the debility and the absence of pain on pressure 
would lead the inexperienced to believe impossible. I have 
seen death following; in twelve hours after a contusion of the 
abdomen produced by a kick from a horse; yet, in this case, 
extensive adhesion and effusions of lymph, and purulent mat- 
ter were found on examination in the abdomen. The patient 
did not complain of severe pain, nor was the pulse at the wrist 
perceptible at any time after the accident. 

When a person has received a severe contusion of the abdo- 
men from the pressure of a heavy weight, Gr the impulsion of 
any large body, the bladder is very generally found in a state 
of temporary paralysis, even when no injury has been inflicted 
on the spine. One of the first things demanding attention in 
these cases is, therefore, the introduction of the catheter, if 
the bladder be not effectually evacuated within twelve hours 
after the accident — and the instrument must be employed at 
least once every day until the organ recovers its tone. 

In every instance of- injury of the abdomen, a surgeon will 
be consulted, of course, if professional aid can be obtained. 
When this is impracticable, the greatest care of the attendants 
should be to do as little as possible. The case is generally 
safest in the hands of nature, until fever comes on, when it 
must be met by the lancet, cooling drinks and a rigorous diet. 

One caution should be always observed from the first. The 
quantity of food or drink admitted into the stomach at any 
one time must be very small, as any effort at vomiting pro- 
duces a very unfavourable effect. If, as sometimes happens, 
vomiting be produced by the accident, it is right to adminis- 
ter occasionally a little lavender compound, strong mint tea, 
the camphor julep, or some other of the many popular reme- 
dies for sickness; but this must be done with great care, lest 
by their stimulating effect, these remedies should increase in- 
ternal inflammation. Obstinate vomiting will not unfrequently 
yield to the application of a spice plaster to the pit of the sto- 
mach. In cases of extreme depression, when it seems abso- 
lutely necessary to sustain the patient by some stimulus, it may 
be proper to give a table-spoonful of the terebinthinic mix- 
ture every hour or two. 

The best way of making this mixture for such a purpose^ 
is as follows: 

Place in an eight-ounce vial, 

Pure Spirits of Turpentine, 1 drachm. 



278 OF CONTUSIONS OF THE PERINEUM. 

Oil of Peppermint, 2 drops. 

The whites of two eggs. 

Shake these well together, and then add, by little and little, 
six ounces of sweetened water; agitating the mixture frequent- 
ly, and always shaking the vial before giving a dose. 

A patient who has been subjected to an accident of this cha- 
racter, should be kept in bed and at rest until his energies have 
been in a great degree recovered, and all danger of inflamma- 
tion has passed away. Several weeks are sometimes necessary 
for this purpose; and even for a longer period, strict caution 
in regulating the food and drink of the patient is highly ne- 
cessary; for the abdominal organs, weakened by the accident, 
should not have their functions called into play unnecessarily 
until they have enjoyed a long repose. 

Of Contusions of the Pelvis and Perineum. Among the 
most serious consequences of contusions of the perineum, is 
the injury done to the urinary organs by these accidents, and 
the subject thus becomes connected with contusions of the ca- 
vity of the pelvis. 

The most common causes of such injuries are falls upon the 
rail of a fence, the edge of a cart wheel, or some similar nar- 
row body when the legs are expanded so that the blow is re- 
ceived directly on the perineum, or soft parts between the 
buttocks. 

The irritation resulting from these injuries is very great, and 
the consequent inflammation and fever, severe. But the more 
immediate result will claim our chief attention. The urethra, 
or canal by which the urine is discharged, almost invariably 
suffers a severe spasmodic contraction, a contusion which de- 
stroys its powers for a time, or an actual laceration. In all 
these cases the flow of urine is arrested, and the bladder be- 
comes permanently and dangerously distended. After a cer- 
tain length of time, the urine may begin to dribble away bv 
drops, or it may be discharged frequently and in small quan- 
tities by the will, but without effectually relieving the bladder. 
When a laceration of the urethra has taken place, more or less 
discharge of blood, or bloody urine occurs, and in some rare 
instances, the blood regurgitates, or flows back into the blad- 
der so as to fill that organ with a solid coagulum, thus com- 
pletely clogging the outlet. This last occurrence has been 
held a fatal one by many surgeons; but if a catheter can be 
introduced fairly into the bladder, as has been done by practi- 
tioners of superior skill or remarkable good fortune, the case 
is not peculiarly difficult. A portion of the coagulum may be 
washed away by injecting warm water through" the catheter, 



OF FRACTURES OF THE PELVIS. 279 

and then removing it again by the suction 1 of the syringe; af- 
ter which, the urine itself will rapidly dissolve the coagulum. 

As the condition of the parts renders the introduction of a 
catheter, in contusions of the peritoneum attended with sup- 
pression of urine, a very critical, although a necessary step, 
the operation should never be attempted except by a practical 
surgeon, and the aid of such a one should be immediately 
sought. If the instrument cannot be introduced, it may be- 
come necessary to tap the bladder. 

When spasmodic stricture occurs, which may be known by 
acute pain in the part, and by violent straining, it is improper 
to apply cold: however severe the consequent inflammation 
may be, warm fomentations arc productive of much more re- 
lief. One of the best applications is a warm poultice of hops 
or chamomile. When there is no spasm, cold may be usefully 
employed, as in other inflammations. If there be laceration 
of the urethra, an abscess and mortification of the loose cellu- 
lar tissue about the perineum, terminating in fistula, will almost 
invariably follow, unless prevented by the most consummate 
skill. 

It is right to combat the inflammation consequent upon 
contusions of the perineum, by the most vigorous measures in 
the first instance, if the severity of the injury have not pro- 
duced a collapse; for if the first few hours be lost, the rapidity 
of the changes in a part so remarkable for active vitality, ren- 
ders the formation of an abscess almost certain. The free use 
of leeches and the lancet, are highly necessary in attempting 
to arrest the inflammation; but if a tendency to form matter 
be perceived, it should be encouraged by the application of 
emollient poultices; and the abscess, when formed, should be 
opened by an early and free incision. 

Fractures of the Pelvis. — These accidents are generally 
fatal, but they owe their fatality less to the injury done to the 
bones than to the contusion of the soft parts within the pelvis, 
or the rupture of the urethra, and are, therefore, properly 
considered in this place. 

The most common causes of these fractures of the pelvis 
are the falling of banks of earth/ or the passage of heavy ve- 
hicles over the part. Sometimes the wing, or upper part of 
the ilium (see p. 42,) is broken; and I have known a patient 
to recover from a fracture of this kind almost without an un- 
pleasant symptom. Sometimes the fracture runs into the 
socket, of the head of the thigh bone; then all motions of the 
corresponding member are terribly painful, if not rendered 
impossible; and if the patient recover, it is generally at the 
expense of permanent lameness. Much more frequently, the 
bones of the pelvis give way in front and at the sides of the 



280 OP FRACTURES OF THE PELVIS. 

perineum; and, as these parts are deeply imbedded, and give 
attachment to powerful muscles, it is impossible to contrive 
any mechanical apparatus capable of retaining the fragments 
in their proper places. They are almost sure to wound or 
bruise the urethra, bringing on obstinate retention of urine; 
and such cases have invariably terminated fatally. 

So severe an injury as a fracture of the pelvis is commonly 
attended by a profound collapse of the system, and some days 
usually elapse before inflammatory symptoms or fever begin 
to appear. The existence of the fracture is known by the in- 
ability of the patient to assume a sitting posture; by extreme 
difficulty and pain when the lower extremity is moved, al- 
though, when measured, it is found to retain its natural lei 
and by a dull grating, perceptible by the feeling of the pa- 
tient, if not by the ear of the surgeon or attendant. 

The only precautions which can be taken, with safety, 
the unprofessional attendants, to promote the safety of the pa- 
tient, in fractures of the pelvis, until surgical aid can be ob- 
tained, are tin 

The utmost care should be used in c g the patient, 

from the place where the accident happens i hamber. 

The horizontal position should be | 

the body supported by two as- who' 

should face each other, crossing and interlocking their hi 
first, beneath the shoulders of the patient, and then behind 
his buttocks. Another assistant should take charge of each 
lower extremity, placing one hand behind the thigh, a little 
below its middle, and the other beneath the calf of the 
These four assistants should walk sideways in carrying the 
person. A fifth assistant should follow, holding in charge the 
head of the patient All hurry should be avoid* hour 

or two of time are not very important in such cases; and none 
of the above details should be neglected unless by necessity. 

When arrived at the chamber, the patient should not be 
put to bed until he has been undressed, and, in i \ this 

purpose, it is extremely improper to attempt the removal of 
coat, waistcoat, or pantaloons entire. A plain bench, board, 
settee, or long table should be chosen, and covered with a 
narrow mattress, or blanketing many times folded. On I 
after turning up the tail of the coat, the patient should be 
gently laid upon his back. One sleeve of his coat being ripped, 
or cut, from the wrist to the shoulder strap, the latter 
and the collar cut through, or ripped from the facing, the g 
ment is readily removed by gently raising the shoulders and 
passing to the opposite side, without disturbing tin 
The shoulder-strap of the waistcoat being cut, ami the collar 
detached, it may be removed in the same manner. N 



OF CONTUSIONS OR SPRAINS IN THE JOINTS. 281 

having taken off the suspenders, let the waistband of the pan- 
taloons be divided on each side, and rip down the outer seams, 
by the pockets, to the middle of the thigh, or farther. The 
back part of the pantaloons may now be doubled backward, 
and gently drawn down beneath the pelvis; but we should 
never attempt to pull it down by taking hold of the legs, in 
the common way, as this will produce terrible pain in most 
eases. The difficulty is now chiefly over; but, if the stock- 
ings require removal, or if, before undressing, it be necessary 
to withdraw boots, the knee must be firmly grasped by an as- 
sistant during the operation. 

The bed being properly prepared, (it should be a fracture 
bed, see Index,) a long, soft, roller towel, or folded muslin 
sheet, is laid across that part of the bed where the pelvis is 
intended to lie, and just high enough to avoid the danger of 
becoming soiled by the evacuations. The patient being lifted 
in the same manner as at first, is then placed on his back, in 
a proper position in bed. If, on trial, it be found that he ex- 
periences some relief by being slightly turned to one or the 
other side, this may be permitted; and if the ends of the towel 
be now brought forward and firmly and smoothly pinned, it 
will be seen that the pain is either decidedly increased or 
somewhat relieved by the pressure: accordingly, it should 
be continued or laid aside. 

This and strict repose are all that can be prescribed for the 
relief of the fracture, separately considered, by unprofessional 
hands, under any circumstances. The treatment of the ac- 
companying injuries within the pelvis, or in the perineum, 
must be conducted on the plan already laid down for contu- 
sions of those par 

\\ e have been very particular in our remarks on the mode 
of handling the patient, not only because it is of the utmost 
importance in the rare cases of which we are treating, but, 
also, because parts of the same process are requisite in the 
management of several other injuries of more frequent occur- 
rence; and the reader will have occasion to refer to these re- 
marks hereafter. 

Of Contusions or Sprains in the Joints. — The nature 
of these accidents is so well understood that it seems scarce- 
ly necessary to describe it. But there are some circum- 
stances, however, which are deserving of notice. In every 
severe sprain there exists an internal wound, more or less 
extensive; and, consequently, we frequently observe extra- 
vasations to a considerable amount, which often continue to 
require treatment after the inflammatory symptoms have dis- 
appeared. 

36 



2S2 OF CONTUSIONS OR SPRAINS IN THE JOI> 

In accidents of this character the ligaments of the joints are? 
more or less lacerated, torn from their connexions, or vio- 
lently stretched. It is found that a ligament which has un- 
dergone a great deal of extension, recovers its tone and con- 
tracts to its original dimensions with extreme slowness: the 
joint therefore remains weak for many months, and frequently 
requires a mechanical support for its protection. 

The first objects in the treatment of sprains, are the relief of 
the violent pain produced by the stretching or twisting of the 
ligaments, and the diminution of the danger of severe inflam- 
mation by preparatory measures. The excess of pain beii. j 
itself, an active agent in producing inflammation, the rem 
adapted to one of these purposes are generally equally appli- 
cable to the other. In patients with healthy constitutions, 
when neither threatened with the rheumatism nor consump- 
tion, a running stream of cold water furnishes means oi 
fecting both designs In a most speedy and effectual manner. 
This remedy, of course, is inapplicable to sprains of the hip, 
shoulder, or spine; but in those of the knee, ankle, elbow and 
wrist it is attended with the happiest cflccts. The full stream 
of a pump or hydrant falling upon the injured part increases 
the pain, in the first instance, sometimes to a deg i ecly 

tolerable, but if the application be continued, the part becomes 
benumbed, and the pain soon ceases. In from ten minutes 
to half an hour, according to circumstances, this eilect is pro- 
duced. This application should be made as speedily as pos- 
sible after the accident, and must not be arrested until the 
sensibility of the part is much diminished, or it will pro- 
duce injury rather than benefit. 

In sprains of the thigh, shoulder and spine, rags wet with 
cold lead water may be substituted, and should be frequent! v 
changed until the heat of the part is reduced. 

In patients subject to consumptive disease, or rheumatism, 
and fearful of the application of cold, we may ofien g 
great relief, by pouring on the part a stream of moderately 
warm water, after which the part may be enveloped in a ban- 
dage thoroughly imbued with laudanum. These precautions 
being taken, the patient is seated with the injured part in ai. 
vated position; or, if ill bed, it must be supported by pill 
The most absolute rest ol^ the limb must be strictly enjoined 
upon the patient. "When inflammation has become established, 
the most rigorous local treatment is proper. The diet should 
be low; and. if fever appears, some blood maj 
arm to advantage. This course should be continued until 
inflammation has in a great degree subsided. Repeated let 
and the constant use of cold ablutions will be beneficial du- 
ring the inflammatory After the lapse of li\ 



OF PUNCTURED WOUNDS. 2S3 

days, some change of treatment is required; the vital energies 
of the part have heen exhausted, the ligaments have lost their 
tone, and the ahsorbents can no longer take up the extravasated 
blood with freedom. Gentle stimulants will now give vigour, 
and hasten the cure. Bathing with one of the following ar- 
ticles, which are arranged in the order of their energy of ac- 
tion, will generally be found advisable as the case advances.* 
Warm vinegar, warm brandy or whisky, the soap liniment, 
camphorated spirit, volatile liniment, spirits of hartshorn, 
spirits of turpentine, decoction of cantharides. As a general 
rule, the deeper the joint, the more powerful is the application 
required in the chronic stage. Sprains of the spine, parti- 
cularly, which endure for a long time, are sometimes much 
benefited by frictions with the decoction of cantharides in 
spirits of turpentine. In persons subject to rheumatism, the 
injured joint is exceedingly liable to attack during the chronic 
stage of the sprain. The terrible suffering which results, is best 
relieved by poultices of hops and vinegar, or by the applica- 
tion of plasters composed of two or three drachms of some 
strong narcotic, such as the extract of belladonna, hellebore, 
or stramonium, mixed with half an ounce of lard. During the 
chronic stage, the patient should gradually return to his usual 
habits of diet, and the injured joint may be carefully subjected 
first to passive, then to active motions, to prevent permanent 
lameness. These exercises should not, however, I)' 4 carried 
to such an extent as to give the patient pain. When the 
joint continues feeble for a long time, it is best to embrace it 
firmly in an elastic flannel bandage; or, if necessary, com- 
plete support may be given by means of a proper splint. In 
very bad cases, months may elapse, before the extravasated 
blood is totally absorbed; and a much longer time may fre- 
quently elapse, before the distended ligaments recover their 
tone, and restore the joint to its primitive strength. A severe 
sprain is a more serious accident than a fracture, and should 
never be ignorantly trifled with, or neglected. 

Of Punctured Wounds. — It has been customary to treat 
distinctly of those wounds which are made by long narrow 
instruments, but which do not penetrate cavities, under the 
head of punctured wounds. The peculiarities of wounds of 
this character have been very much exaggerated, and the 
measures taken to prevent evil consequences from them are 
often productive of serious mischief. 

If a narrow and deep puncture inflame, the swelling of its 

* Those articles which stand last on this list, are only serviceable in old and 
severe cases. They are rarely useful within a month after the accident; and 
as most sprains recover in less than a month, they seldom come into play. When 
med too early, they are very injurious. 



284 OF PUNCTURED WOUNDS. 

walls occasions very painful pressure on the nerves of the 
part; and if, as often happens, the instrument have penetrated 
a fascia, or tendinous expansion — (see Index,) — the inflamma- 
tion, and the consequent pressure of the parts beneath against 
the unyielding fascia may be spread over a wide surface, and 
produce not only extreme agony, but serious danger to life, 
even when the extent of the original wound is inconsidera- 
ble. Nothing can be more irrational than the popular mode 
of treating accidents of this character, which consists in soak- 
ing the wound w r ith spirits of turpentine or strong lie, for fear 
of lock-jaw. That there are no cases of punctured wounds 
in the palm of the hand or the sole of the foot, id which be- 
nefit may result from strongly stimulating applications made at 
a proper time and more proper manner, I will not pretend to 
say; but this is certain; — in nine cases of ten, the practice will 
be attended with most unfortunate consequences, and it would 
be extremely silly for any one unacquainted with surgery to 
judge what cases would prove exceptions to the general rule. 

Punctured wounds occurring in warm weather, and t 
cially such as are located in the foot or hand, require careful 
watching and surgical advice; but the only safe course for the 
domestic adviser, when a surgeon cannot be procured, is as 
follows. 

Immediately on the occurrence of the accident, we should 
order a plain poultice of bread and milk; to which may be 
added, when the wound is extremely painful, about U 
of opium to a tea-cupful of poultice. The opium should only 
be employed at the first dressing, and for the relief of the ner- 
vous pain; for after inflammation has become established, the 
pain will be increased instead of being lessened by such an 
application. 

The poultice should be changed at least once, daily, until 
the violence of the inflammation is over. If swelling extend 
rapidly over the mrrounding surface, and the intense throb- 
bing pain lead to the supposition that beneath 
which the inflamed parts are firmly bound down has been 
wounded, the skilful surgeon will generally make a free inci- 
sion through the wound and the fascia, thus converting the 
punctured into a simple incised wound. 

The part, which has received the wound, should be main- 
tained constantly in an elevated position, until the inflamma- 
tion has subsided. If the arm — it should be carried in a sling: 
if the leg — it may be supported by one or more pillows in bed, 
and upon an extra chair during the da v. These wounds 
scarcely ever heal by the first intention, but rarely occasion 
much suppuration, unless they produce a d< 
When the amount of discharge begins to decline, or when the 



DILATATION OF NATURAL PASSAGES. 2S5 

\ 

parts about the orifice appear much weakened, the poultice 
should be omitted, and a dressing of simple cerate with a 
loose bandage, applied in its place. The most perfect repose 
of the limb is often of absolute necessity in deep punctured 
wounds of the extremities, and suitable splints are then re- 
sorted to. 

When a punctured wound remains many days but little al- 
tered in appearance, and instead of pouring out healthy pus, 
yields scarcely any discharge, and presents a gaping orifice, 
lined with a ragged ash-coloured membrane, there is danger 
of some serious disturbance of the general health, predisposing 
to nervous spasms or lock-jaw. These are the circumstances 
which demand the application of local stimulants to the 
wound, but we do not deem it prudent to prescribe any par* 
ticular plan of local treatment in a popular work. All that 
can be safely done by the domestic practitioner, when surgi- 
cal advice cannot possibly be procured, is to keep the patient 
on ■ very mild though somewhat nutritious diet, giving ten 
or fifteen drops of Elixir of Vitriol in a tumbler two-thirds 
full of water, repeating the dose twice or thrice every dav. 
The bowels should be kept open, one or two free discharges 
per diem being secured, if necessary, by mild purgatives. 
For children under I of age, a Seidlitz powder or a 

small dose of Epsom salts will answer the purpose; but for 
adults, it is better to employ some combination containing a 
portion of calomel. Bight grains of rhubarb, and three 
grains of calomel, formed into three pills, or taken in powder, 
with molasses or brown sugar, will be found a safe and elli- 
cient dose, and will usually leave its impression on the bowels 
for three or four days, before it becomes necessary to repeat 
the prescription. 

For some remarks upon poisoned wounds, and the compli- 
cation of wounds with certain troublesome forms of inflamma- 
tion, the reader is referred to the medical portion of this 
work, where the subject of Erysipelas if treated of — that cu- 
taneous disease being somewhat closely associated with many 
accidents following the iniliction of wounds. 



SECTION II. 

On the Dilatation of Natural Passages, and Us Con- 
sequenccs. 

Next to the actual wounds of parts, it is natural to consider 
their stretching or permanent distention: several accidents of 
this description may be properly discussed in a popular work; 



DILATATION OF NATURAL PA 

but, before entering on the separate classes of these acci- 
dents, it is necessary to premise some general remarks. 
. The hollow viscera, the blood vessels, and other canals of 
the human body, are all intended to contain certain soli' 
fluids, varying in quantity from time to time, and they are all 
furnished with a coat of muscular or other contractile fibres, 
which adapt their dimensions to the quantity of their con- 
tents, as has been described in the anatomical chapter of this 
work. But this power of adaptation has its limits. If n< 
or quite all the contents be excluded for a length of time, the 
diameter of the canal is continually lessened, not only by the 
increasing contraction of the fibres, which cannot be carried 
very far in all cases, but also, by an interstitial absorption, which 
gradually renders the coats thinner and shortens the 6 
J f all contents be absolutely excluded, and the continue"! 
elusion be consistent with life, there exists no limit to this 
absorption, until the portion of the rendered 

i totally i revious I 

enee remaining, cord of dense cellular tissue, 

resembling a delicate roiio at. 

If, on the contrary! the i <>f a natural canal be fre- 

quently or for considerable periods, increased beyond all 
proper or customary amou .'lies perman< 

dilated, and the fil g to their 

natural dimension-. We have spoken of th 
ring to the bladder, in the Phj . apter, and to the 

stomach, in tin- hygienic section on food: our busi- 

ness is with other effects of similar causes. 

This dilatation, far from being generally productive of thin- 
its of the canali is usually attended with much 
thickening and increased Btrength, which is the result 
hyper-nutrition, by means h nature attempts forcibly 

to resist t he distending power. T 

are often found thus enlarged to the th'u one-fourth of 

an inch; thearter Halation, or in aneurism, which 

is a somewhat compli rionally found 

with walls much thicker. The abdomil I and tendons, 

in old hernia, not unfrequently present us with a section 
measuring ten times the natural amount. 

But if the distending force 1 . and the com 

of the canal be continually on the i 

action constant, (as in aneurism, where the | the heart 

perpetually tends to press more blood into the tumour) the 
powers of nature are at last exhausted, the hyper-nutrition 
>, and this occurs sooner in just proportion to the im- 
portance of the organ affected. When this state of thin— - 
established, the increasing press the conto 

a rapid absorption of the walls oi the canal, particularly . 



DILATATION OF THE AM'S. 287 

weakest part, and the cavity bursts sooner or later, unless the 
death of the patient prevent the issue. 

We have clearly indicated, in the foregoing remarks, the 
nature of the accidents spoken of, and the principal morbid 
changes caused by them. The most rational plan of treatment 
is plainly deducible from the same remarks. It consists in 
evacuating, as far as possible, the contents of the canal, and in 
permanently preventing their .nidation in improper 

quantities; leaving the natural operation of a well known law 
of physio! feet the gradual reduction of the passage by 

interstitial absorption. Other measures than these are required 
only where the functions of t!. elude the applica- 

tion of mechanical contrivances or operation- mor- 

bid w< of the p u>e of dilata- 

tion under the action of its ordinary functions; and in i 

complicated with d Dal superindu 

existing with the dilatation. The last named class is by no means 
a slender one, and some in- complications will 

be mentioned in the | I ction. 

Dilatation qf the-Jlntu* This affection results chiefly from 
the habit of costivem - the frequent of large 

it it is much promoted by all which 

tend to produce relaxation of the part and fulness of the 
morrhoidal vessels: an st important are seden- 

tary habits, luxurious living, and uncleanlii 

The ill disa- 

ted with fecal mat- 
Ontinually bathes the part; the patient controls his dis- 

eharges with difficulty, wh ed with the slightest . : 

of the bowels; the inu 1 becomes 

thickened and disi a dull, ! 

pain in the part, and sometime 

One in the muscles which close the 
anus, prevents tbem from yielding the proper mechanical sup- 
port to the hemorrhoid . which are (he principal blood 
the part; and ti. tome cnl I 
and varicose, sometimes pouring out blood into the surrouud- 
ellular tissue, where it forms little sacs, which, becoming 
surrounded by walls thickened by hyper-nutrition, form those 
rery troublesome tumours called pilta. Pil therefore, 
both a cause and a consequence of dilatation of the anus. 

Another very annoying accident, often caused by this dila- 
tation, is prolapsus of the anus, a> it is commonly called. This 
consists, usually, of a falling down or thrusting out uf the mu- 
cous membrane alone, which projects more and more at each 
stool, until it becomes altered in structure, and is. at length, re- 
turned with difficulty. Sometimes, however, it is the whole 



288 DILATATION OF THE ANUS. 

thickness of the intestine which descends, being doubled within 
itself, like the finger of a glove; and the case is then much more 
serious. 

In the treatment of dilatation of the anus, mechanical inge- 
nuity is of no avail ; the parts are beyond the reach of any com- 
pressing force, except that of their own muscles. The first 
object is to remove the cause, namely, the occasional passage 
of hardened fasces in large masses. To effect this, it is neces- 
sary to correct the diet by the avoidance of rich food, wines, 
and much spice, in order to lessen the disposition to costive- 
ness; and then, to employ such measures as tend directly to 
keep the bowels open. Gentle purgatives and laxatives, such 
as the Seidlitz powder, Epsoi. ;istor oil, rhubarb, <x.e. 

may be required occasionally; but it would be extremely im- 
proper to depend exclusively upon medicines, in cases requir- 
ing a long continued course of treatment. There are many 
articles of diet, of an opening quality, and these should be the 
main dependence of the patient. Among the best of then 
such articles as admit of the use of sweet oil, which should be 
employed freely, and such tl I with in :nush 

and molasses act very powerfully in keeping the bowels open, 
and form favourite remedy with the late Dr. Ph\ 

The bowels being duly regulated, the next object is to in- 
K the tone of the sphincters; anil this is best accompli 
by cold ablutions and I The proper mode of apply- 

ing cold is by means of a stream of cold water bearin^ 
rectly on the part. In some of our large cities this is l 
managed, by standing in a bath tub, beneath a hydrant, and 
allowing the water to flow upon the anus; but the apothec 
have always on Bale, a large syringe for self-injection, which, 
by throwing its stream perpendicularly upward, is admirably 
adapted to the treatment of diseases of the anus by cold w 
This remedy • g contraction of the coats of the blood 

Is, expelling one cause of distention, while it produces an 
increased tone in the sphincters, thus diminishing the diame- 
ter of the canal. The ell. omote the re- 
gular action of the 1> -hen the external 
sphincter of the anus, which, contrary to the common opinion 
of anatomists, is a voluntary muscle; anil an i: I f its 
strength by exercise, has an important influence on the dimen- 
sions oi' the anus. The exerci>es which tend most powerfully 
to effect this purpose* are dancing, running, leaping, and jump- 
ing the rope. These are not only useful in producing a dimi- 
nution in the canal, but they also tend, by increasing the tonic 

-ire of the muscles, to remove piles, when alreadv I 
ing, and, by promoting cleanliness and relieving irritatit : 
check the disagreeable mucous dischai "g 



DILATATION UF THE ANUS. 2S9 

When the habitual moisture of the part gives rise to very 

troublesome itching or painful excoriation, the greatest relief 
is obtained by introducing into the rectum a very small sup- 
pository of tallow or suet before going to stool, and by keep- 
ing the orifice constantly dusted lightly with prepared chalk 
or the carbonate of zinc, during the intervals between the daily 
use of the cold water. 

Although piles are spoken of as one of the consequences of 
this form of dilatation, yet these tumours are so important, and 
arc produced in so many other ways, that it is much better to 
treat of them in another place. 

The prolapsus ani, or coming down of the anus, is not al- 
ways attended by the dilatation of the canal, for it may be pro- 
duced by severe straining at stool at any lime, particularly in 
children; and it may occur as a symptom of certain other dis- 
eases; but this be the most proper place to notice it. 
The accident may be recognised by the formation of a soft red 
tumour all around the anus, at every stool. This, at first, re- 
tires of its own accord in most cases, immediately after the 
close of the evacuation; but as it continually increases in size 
by repeated descents, it soon requires the aid of the lingers to 
replace it. After a time, its bulk becoi. great that 
this is difficult, and in some sadly neglected ^possible. 
The prolapsed part soon becomes subject to inilamma- 
. which thicken it permanently, weakening the patient 
by a perpetual discharge of nutter, and rendering reduction 
extremely difficult and painful. Sometime! the tumour be- 
comes strangulated by the sphincter muscles: the pain is then 
horrible, all die arc arrested anil, unless relieved, the 
lie; but some instances have occurred in which 
the protruded part has mortified and (alien off in time to 
life, without any surgical operation. In old cases, the pro- 
traded part, even when of enormo as been known tu 
remain down for years without preventing the evacuations; 
and the mucous membrane, in these cases, becomes gradually 
converted into skin! 

To reduce a bad prolapsus an i,wc should commence by pouring 
freely over the part cold or tepid water, according to the condi- 
tion of the constitution and the degree of inflammation in the tu- 
mour. The patient is then to be placed on his back in bed, with his 
buttocks drawn down nearly to the foot, his shoulders and but- 
tocks well raised by cushions, and his heels drawn up to his 
thighs, An operator with smooth hands, well greased with 
lard, places himself at the foot of the bed, and presses the tu- 
mour gently upwards, with the palm of one or both hands, ac- 
cording to the size of the swelling, for a considerable time. This 
pressure is designed slowly to empty the blood vessels, and 

37 



290 OF VARICOSE VEINS. 

thus diminish the projecting mass. The assistant then conti- 
nues the pressure with the fingers of both hands, while, with 
both his thumbs, he gradually and slowly thrusts the central 
portions of the tumour from without inwards toward the lit- 
tle depression which marks the extremity of the canal of the 
gut. Thus, those portions which descend last are reduced 
first; for it is folly to attempt to return the whole ma- 
once. When the reduction is apparently complete, the fore- 
finger of the right hand, well oiled, should be introduced as 
high as the middle of the third joint, to place the last folds en- 
tirely clear of the canal of the anus; and the patient being 
directed to avoid all straining, the finger is to be withdrawn 
very slowly, by turning it gently, first in one direction and 
then in the other. 

If the case be very painful, and the patient strong, he may 
lose blood from the arm pretty freely before the operation. 
If the inflammation be very great, and the tumour appear 
likely to prove very obstinate, small leeches may be plenti- 
fully applied before the cold. In bad cases occurring in adults, 
forty drops of laudanum may be given fifteen minutes before 
the employment of pressure. 

The reduction being completed, and the patient made com- 
fortable in bed, if no laudanum have been given previously, the 
dose just mentioned should be now administered, to check 
any call to stool for a day or two; and the food allowed should 
consist of gruel, exclusively, for some d BT which, the 

rules of diet laid down lor cases of dilatation must be ob- 
served. 

Mr. Gooch invented a peculiar truss, to prevent the protru- 
sion between the stools which is apt to occur spontaneously 
in very bad cases o{ dilatation of the anus. This instrument is 
noticed in the American Cyclopaedia of Practical Medicine, 
Art. Anus. By referring any intelligent surgeon's instrument 
maker to this work, with a note of the height, and the mea- 
sure of the circuit of the pelvis, the patient may obtain the 
machine to order at any time. 

The above directions are all which can be given with any 
safety, to the best informed domestic practitioner. For the 
relief or cure of even the worst cases of prolapsus ani in which 
the above described measures fail, mar . but sue 

ful surgical operations may be performed; but these require 
high skill, and the very description of them would be unin- 
telligible to most of our read* 

Of Dilated, or V arian t Perns. — The eficet of the weight 
of the column of blood in distending and rem! -cased 

the veins of the lower extremities, particularly in tall men, 
the effects of tight garters in produei: 



OF VARICOSE VEINS. 291 

the similar influence of the pressure of the womb in pregnant 
women, together with a notice of the local dropsies, or swell- 
ings, of the legs which are consequent to this embarrassment 
of the circulation, have all been mentioned in the first part of 
this work. (See Circulatory Apparatus.) 

When varicose veins are bad, the whole of the affected limb 
appears as if enveloped beneath the skin by innumerable large, 
blue worms, while the skin itself presents multitudes of redder 
tortuous lines, which might be mistaken for their infant pro- 
geny. These are the dilated veins, with their coats enor- 
mously thickened by hypernutrition, or morbid nutrition. 
Along their route we observe, every here and there, a hard 
knot, or tumour; this is a valve, morbidly altered in texture, 
and rendered useless by the disease. The circulation through 
these enlarged canals is slow and difficult, so that the blood 
actually coagulates in places along the sides of the vi- 
and, notwithstanding the increased nutrition of the co 
the veins, and the serous deposits in the cellular tissue which 
often enlarge the whole member prodigiously, the general nu- 
trition of the limb is rendered extremely feeble and ineffi- 
cient; the muscles losing their colour and strength rapidly. 
After a time, it often happens that nutrition ceases altogether 
in places, and these parts being removed by the absorbents, 
extensive ulcers, which are nearly or quite incurable in their 
nature, are created. We may heal them again and again 
in some i—UneOS, but the moment the patient quits his bed 
and attempts his usual avocation they tie alniusl sine to recur. 
Our only resource is the partial relief of the varicose condi- 
tion of the veins h\ surgical measures, for a complete cure of 
this affection we hold to be impossible* 

It would be a reasonable inference that, as the pressure of 
the incumbent column of blo«n| is the principal cause of vari- 
cose veins, the recumbent position would be the best during 
the treatment. But, it is found that the removal of the accus- 
tomed and natural pressure from the veins soon produces a 
loss of tone which causes them to yield to distention the mo- 
ment that pressure is restored. Although the vessels when 
in health soon regain their power, becoming even stronger 
in consequence of the previous repose, yet, when diseased, 
the immediate mischief resulting from the subsequent disten- 
tion outweighs the benefit of the repose. It is best, therefore, 
when treating varicose veins, or the ulcers which they produce, 
by means of remedies which admit of such course, that the 
patient should be permitted to rise, or even to walk about 
during the day. All advantages actually gained under such 
'urcumstances may probably prove somewhat permanent 

The most powerful, while it is the safest measure for the re- 



292 OF VARICOSE VEINS. 

lief of varicose veins, is pressure. This is effected by means 
of bandages, or adhesive strips. The latter are objectionable, 
because they irritate the skin, and provoke ulceration. 

In applying a bandage for this purpose it is absolutely ne- 
cessary that the roller should commence at the very toes, 
where its pressure should be greatest, and that it should press 
regularly and smoothly on every part of the limb, up to the 
summit of the enlarged veins. It is improper that the pres- 
sure should he very firm at any point; for strong compre 
continued for any considerable length of time invariably 
weakens the capillaries so as to occasion at least a temporary 
enlargement on the removal of the bandage. We think there 
is even an advantage gained by removing the pressure daily 
for an hour or two, to accustom the to the force of the 

circulation while the patient is in a recumbent position. 

Practised surgeons generally prefer domestic muslin for 
making their ban.. B f the hands of the skilful, it 

is applied with gi racy and security -light ir- 

regularities in such a bandage arc often productive of the 
must serious irritation in consequence of the unyielding cha- 
racter of the material, it is unsafe in unprofessional bands. A 
much better article for domestic practice is the common 
flannel, which is elastic, and slight irregularities in the appli- 
cation arc, therefore! less important. 

This pressure by bandage must be kept up for many weeks 
in order to produce any beneficial change in the coats of the 
veins, and even then, as the principal cause of the disease, 
namely, the pressure of the column of blood, cannot be 
moved, there is a very strong probability that the disease will, 
ere long, return in full force. To prevent this, it is customary 
to wear a laced stocking of woollen netting or buckskin, which 
will permanently assist the vessels in supporting the weight 
of the blood. 

When var'w 1 arc complicated with ulcers of the 

. the latter require a local treatment that will not ink: 
with the application of the bandage. It is usual, and] 
lievc, proper to draw the l the ulcers slro; g 

ther by long and broad strips of adhefl iter, until the 

size of the sores is much diminished, or until a diffused 
ness of the skin and an eruption round the atripi tam- 

ing that the skin is intolerant of the plaster. Over the adhe- 
sive strips, or if these be not employed, immediately on the 
sore, we lav a piece of muslin or patent lint spread with sim- 
ple cerate or basilicon ointment j enough 
the ulcer. On this, again, we place a thin com; >me- 
what larger dimensions, and then pi *PPty lne l Vi 
bandages, The ulcers should be washc 



OF VARIOCELE. 

and water every time the dressing is removed] and if the 

ointments be found, after a time, to disagree with them, their 
surface may be dusted with powdered chalk or the carbonate 
of zinc, for two or three days; alter which the ointments may 
be reapplied. 

The attempt is sometimes made to etlect a cure of varicose 
veins by means of a surgical operation, and partial success is 
occasionally obtained. Nearly all the superficial veins of the 
lower extremity are first collected into a few great (rank 
the inner side of the thigh; and these, again, are finally united 
into one. The operation of which we are speaking consists 
in cutting out about half an inch of this single trunk, or of the 
two or three which immediately form hat when the 

wound is healed, the route of circulation through these veins 
may he ai blood CO flow through 

deeper channels. It is found that nature, begins to contract 
the dilated canals as soon as the amount of circulating fluid 
and the direct pn the whole column of blood have 

been diminished by the operation. 

kocde. — This difl exceedingly common. It 

consists in a varicose condition of the veins of the spermatic, 
cord; and it ifl narkable that, in nine : ten, the 

left testicle only is effected. The complaint gives rise to a 
dull, heavy pain or uneasiness about tl. . 1 in had 

. the gland 10 often diminished in size. When varicocele 
occurs, as it very often n of the i 

moral habits, it will be generally found to disappear sponta- 
neously after marriage. 

The disease is frequently mistaken for hernia, and this error 
von been committed by regular medical practitioi 
though such an extremity of care! ifl hardly credible. 

The deep blue of the enlflu is seen through the .skin 

in sou . and the wormy or knotty and tangled feeling 

of the tumour when rolled between the thumb and finger, 
are signs sufficient to enable the patient himself to distinguish 
between this and every other alfection of similar parts. r J nere 
are, it is true, certain complicated i which it is not 

quite so eas eive the true character of the complaint; but 

these are rare; — they cannot be judged of by the unprofession- 
al, and, therefore, need not be here described. 

1 ne proper means for the cure of varicocele are simple, 
and readily practised. Cold bathing, and the local applica- 
tion of a stream of cold water, are very important measures; 
and it is advisable, also, to avoid a habit of costiveness, which 
tends very strongly to increase the disease. General ami free 
exercise in the open air is highly serviceable, but the remedy 
on which our main dependence should be placed is a proper 



294 OF HEMORRHOIDS OR PILES. 

suspensory bandage, an article on sale at all apothecaries* 
shops. Unfortunately, however, most of these bandages are 
miserably mal-constructed. They are made non-elastic in the 
body-band and thigh straps, which should yield, in order to 
render the patient comfortable, and elastic in the sac which 
contains the testicles, where all yielding in the material inter- 
feres with the special design of the apparatus. These defects 
are remedied in the best suspensory for varicocele which we 
have seen. It is contrived by Dr. Heber Chase, of whose 
trusses we shall have occasion, presently, to speak, and is sold 
by his agent, Samuel Sheppard, druggist, South Ninth Street, 
Philadelphia. No doubt it will become generally known and 
diffused in a short time. 

Some empirics, and certain ignorant inventors or venders 
of trusses for hernia, have the folly publicly to advertise their 
instruments for the cure of varicocele; and we have seen ad- 
vertisements of this character seemingly backed by the fa- 
vourable opinions of men high in the profession. We can 
scarcely believe these signatures to be genuine; but, be thi> 
may, it is our duty to caution those who suffer under the dis- 
ease against the cupidity of any one who would sell such an 
instrument for such a purpose* A truss may. and often does, 
give rise to varicocele, and its application while the disease 
exists invariably renders it worse. We have no patience with 
the grossness of these deceptions, having witnessed so much, 
and such frequent suffering consequent upon them. 

Very numerous surgical operations, and many of them of 
the severest character, have been performed for the cure of 
varicocele; but it is much to be feared that great pain, perma- 
nent evil, and sometimes death, are unnecessarily incurred in 
this manner. There may be occasional cases of varicocele 
warranting the use of the knife, but the dif in a vast 

majority of cases, more readily and effectually relieved by 
measures prescribed above. Varicocele is a source of much 
inconvenience, and sometimes occasions disgusting deformity; 
but it is not a dangerous disease, and we should be careful how 
we institute a dangerous treatment for its relief. 

Of Piles, or Hemorrhoids. — The word pile has been ap- 
plied to so great a variety of tumours about the anus, differing 
more widely in their cause and character than in their appro- 
priate treatment, that it seems necessary to include them all 
under one general head, in a popular work: and as the two 
most common and troublesome forms of disease result from 
dilatations of the venous system, this seems the proper place 
to introduce the whole subject. 

The term hemorrhoids, or piles, is applied to at least t 1 
kinds of tumours, situated about the anus, which it i< very im- 



OF HEMORRHOIDS OR PILES. 295 

portant to discriminate from each other. The first of these 
consists of an enlargement, or dilatation of the veins of the 
part. These hemorrhoidal varices are of a dark bluish colour, 
soft and elastic to the touch, somewhat resembling ripe grapes: 
when compressed by the finger, they are diminished, but re- 
turn to their former state as soon as the pressure is removed. 
These tumours can be traced far up into the rectum. Their 
shape is different from that of other piles; they are broader at 
the base, and rounder. Sometimes they are found distributed 
in clusters. It is principally this kind of tumour from which 
proceed the severe bleedings by which the disease is some- 
times rendered formidable and dangerous. These tumours 
do not often, like the other varieties comprehended under the 
same name, admit of excision. 

The second and most frequent kind of hemorrhoidal tu- 
mours is first seen in the form of small fleshy tubercles, ge- 
nerally of a brownish or pale red colour. They may be situ- 
ated either within the rectum, or about the edge of the anus. 
In the latter case, they are pale, elastic, and have a spongy feel. 
Their surface is smooth, and their appearance semitransparcnt 
Sometimes the anus is completely encompassed by the tumours, 
but more generally they appear on one or both sides, leaving 
an interval. In either case, the shining and smooth membrane 
which covers them appears to be continuous with the lining 
of the lower portion of the bowel, and to possess in a degree 
the same character. They are often found to contain a cen- 
tral cavity filled with fluid or coagulated blood, which appears 
to have entered through the minute vessels. The cavity does 
not usually exceed the size of a pea; but is sometimes large 
enough to contain several drachms of blood. Frequently the 
whole substance of the tumour is infiltrated with bluod, con- 
tained in canals which have lost their original connexions with 
the veins, and when this is discharged, by design or accident, 
it collapses and becomes like a loose fold of skin. These piles 
often subside spontaneously. When such piles have for some 
time been subjected to the pressure of the sphincter from 
above, and of external substances from below, they become 
harder and more permanent, and form a source of almost con- 
stant irritation, preventing the patient either from walking or 
sitting, and causing by their presence an urgency and pressing 
down, which often occasions actual prolapse of the bowel. This 
last condition of the hemorrhoidal tumour which has been just 
described, is commonly called the blind piles, and is found ex- 
clusively about the verge of the anus; but closely connected with 
blind piles, and apparently dependent upon an extension of the 
same morbid actions, arc the caruncular piles or hemorrhoidal 
excrescences, which are of a more indolent character, and often 



2i)C> OF HEMORRHOIDS OR PILES. 

continue when the cause which produced them has ceased to 
operate. These caruncles are soft and compressible, of a red 
colour, and frequently attached by a narrow neck to the sur- 
face of the perineum. 

The third production to which the name of piles is com- 
monly but perhaps improperly applied, is more decidedly of a 
warty character than that just described, is found at a greater 
distance from the anus, and appears to depend on a different 
cause, as it has no apparent connexion with the veins. It is 
easily removed by excision, and requires no farther notice. 

The remote causes which produce the two first mentioned 
forms of piles, are to a considerable extent identical, and are 
numerous. We have already mentioned the effects of dilata- 
tion of the anus in producing them, and we may now mention 
as a frequent cause, a condition precisely the reverse: in 
lav action of the bowels, arising from I inued eostivc- 

ness in individuals of rather rigid fibre. In th< ■ I the 

rectum itself, and the abdominal muscles which act upon it, 
arc thrown into the most powerful contractions in order to ex- 
pel the hardened feces, while the sphincter remains unyield- 
ing and refuses to act in concert. Hence, on every expulsion, 
the mucous membrane of the rectum and the v con- 

tains arc caught and detained, and some of the veins strangu- 
lated by the forcible construct ion of the muscle. This 
gular action of the intestines is also liable to take place v. 
any fixed cause of irritation or annoyaiu •• nt in or about 

the bladder. Thus, the presence of Stone within the cavity of 
the latter organ, or an enlargement of the pi id which 

surrounds its neck, may become a cause of] 
them if already present Enlargement of the liver, or a i 
of pregnancy, by causing pressure on the veins of the p< 
may likewise become a cause of the affection, especially in the 
varicose form. 

We have already intimated that it is the first of the abort 
rietiea of hemorrhoidal affection which h d the name of 

bleeding piles. It does not always happen, however, that when 
the walls of the varicose tumour give \ I ual bleeding 

follows. Sometimes the blood accumulates in the neighbour- 
ing cellular membrane; and the tumour, in place of diminish- 
ing, is very greatly increased. In most cases the whole inte- 
gument yields, ami the bloo forth very profusely. 
peated accidents of this kind will produc ihaostion 
even endanger life, and where this is no* the debility 
consequent on the excessive depletion may bring on dro 
A less direct, but still serious danger from the blec 
that by repetition they will become I habit of the 
tern, which cannot be checked without injuru 



OP HEMORRHOIDAL PILES. 297 

Many of the remedies usually employed to arrest hemorrhage, 
such as cold, pressure, powdered alum, &c, may be employed 
io these cases, when the bleeding points are accessible; but as 
the vessels cannot be tied in most cases, and as patients often 
bleed internally, a surgeon must be called in case of difficulty. 
Local astringents, with low diet and attention to the regularity 
of the evacuations, will generally prevent the return of the 
bleeding. 

In the management of piles generally, however, the regula- 
tion of the bowels forms one of the most important means, 
and one which in ils application is found most difficult. The 
employment of powerful cathartics, instead of diminish- 
ing, will have a direct tendency to aggravate the affection. 
If possible, daily evacuations are to be procured by dieting 
merely, whir it effected by the free use of articles 

•d with oil or molasses. Where this cannot be done, the 
mildest laxatives must be employed. Sulphur has enjoyed 
the credit of being a specific in this disease; a reputation which 
it owes mainly to its power of gently exciting the peristaltic 
action, and perhaps partly to the fact, that, being insoluble, it 
descends in substance to th< portion of the intestine and 

expends its force there. 

When the tumours arc highly irritable and inflamed, the 
treatment is that of local inflammation generally, modified by 
the particular situation of the part. I should first be 

applied, and the bleeding ence the parts may then be 

ting OV< ;iour of warm water or the in- 

fusion of hops, poppiee,4ic. If the irritation be not thus sub- 
dued, a poultice will be found to afford decided relief. The 
tenesmus and straining with which this state is often accom- 
panied, and which make an ftp to that of dysentery, 
will generally icr the introduction of some mild sup- 
pository, as recommended in that i When, by means 
these, the irritability is subdued, somewhat harsher mea- 
Diay be resorted to for the dispersion of the tumours 
themselves. Cold astringent injections and washes, the pow- 
der of galls or catechu, and the dried juice of the garden ce- 
lendine (chelidonium ?najus) ointments, made of the same 
articles, piaster of Paris or fuller's earth, reduced to a paste, 
and the lunar caustic in substance or solution, have been found 
useful; but the latter can only be employed safely by profes- 
sional hands. Frequently, however, all these means fall short 
of the end desired, which is the removal of the source of annoy- 
ance, and then the aid of the surgeon must be called in, to re- 
move the tumour by the ligature or the knife. The choice 
between these must be regulated by the circumstances of 
each particular case. The former is the most painful and te- 

3S 



298 OF ANEURISM. 

dious mode, the latter is in some cases followed by trouble- 
some bleeding. The size and form of the tumours, the mode 
of their attachment, and the general habit of the patient, will 
be kept in mind by the surgeon in forming a decision. 

Dilatations oj the Heart and Arteries. In our rather ar- 
bitrary arrangement of subjects, which by most surgical wri- 
ters are not arranged at all, we can find no better place than 
this for the introduction of aneurisms and other enlargements 
of the arterial system. 

Enlargement of the heart is generally if not always the re- 
sult of some serious constitutional disease, and is any thing 
but accidental in character. Among the most common causes 
are rheumatism and disease of the spine. The subject is in- 
troduced here in order to remove the vulgar impression that 
diseases, or at least changes of structure, in this important 
organ are necessarily fatal. The heart may be greatly en- 
larged, yet under a judicious treatment and regimen, the pa- 
tient may so far recover as to enjoy general good health to 
the end of a long life. 

The heart after dilatation may even recover its original 
dimensions, like any other dilated canal. 

The disease may be recognised by the violent action of 
the heart; by the frequency of palpitations; by the pul« 
the heart being felt over parts of the chest where they are 
not generally perceived; and by a kind of I r rushing 

sound striking upon the ear, when held near to or in contact 
with the chest. This sound has been compared to the blast 
of a bellows, and one very similar is heard in large aneur 
and in hardening of the valves of the heart, as well as in di- 
latation. 

The treatment of dilatation of the heart must necessarily 
consist mainly in removing the cause; be it di :)ine, 

rheumatism, or any other disturbance to the nervous pou 
the organ; but much may be done in some cases, in arn - 
the progress or effecting the removal of the enlargement, 
by lessening the force and frequency of the pulse and the 
quantity of the circu'ati: ends are accom- 

plished by means oi rest, freedom from excitement, the 
ful use of the lancet, strictly D sod mild diet, and the 

administration of digitalis — a reroi i singular in- 

fluence over the pulse, but unsafe in other than professional 
hands. 

Aneurisms are large, pulsating, bloody tumours oc 
by the enlargement or partial ruptu 
be folly to attempt any particular description of lli - 
tions, upon which dozens of volumes have been 



OF VARICOSE ANEURISM. %99 

fice it to state that the coats of the vessel where the enlarge- 
ment occurs are, by some cause or accident, diseased or weak- 
ened to such a degree that they are no longer able to resist 
the force of the blood as propelled by the heart; and they 
yield to the consequent distention until they resemble a thick 
bladder or sac, filled with blood, which goes on continually 
increasing, unless checked by treatment or by nature, until it 
bursts, and the patient dies. It seems to be a general law of 
these enlargements, that the hvpernutrition or thickening of 
the coats, which is often carried to a great extent, is never suf- 
ficient by itself to check the disease; but nature aids this thick- 
ening powerfully f by lining the whole cavity of the aneurism, 
when it ifl large, with layer after layer of firm coagulum; un- 
til, in son iry small portion of the cavity contains 
circulating blood. In a few rare instances, these coagula 
have been known to stop the extremity of the artery where 
it enters the tumour; and the disease has been thus spontane- 
ously cured. Where in aneurism if situated in some internal 
part entirely beyond the reach of the surgeon, if it has not 
advanced too far, there is always a little hope that the precau- 
tions and treatment recommended for enlargements of the 
heart, may prolong life, under tolerably comfortable circum- 
stances, lor many years. 

When the aneurism is accessible, as when it is in the neck, 
on the head, in the arm-pit, groin, or extremities, the 
should he placed at once in the hands of an able surgeon. The 
requisite operation consists in tying ted artery between 

the heart and the tumour, by which means the admission of blood 
through the regular route if , and the contents of tin.' tu- 

mour stagnate and coagula: ) form a barrier against its 

access in other directions. The wails of the aneurism then 
display the tendency to contract which is common to all ca- 
nals when no longer employe'!. 

If the patient live long enough, the whole of the coagula 
may be absorbed, and the cavity may become obliterated. Of 
late years, it has been found that aneurisms which lie beyond 
the reach of the knife may be sometimes effectually cured by 
tying the vessels which lead out of them, instead of seeking 
those which lead into them. The blood then stagnates and 
coagulates^;' want of an outlet, as in the former case , for want 
of supply. 

tlucnrismal ttarix and varicose aneurism are terms used 
by surgeons to express certain accidents which sometimes oc- 
cur in the operation of bleeding from the elbow. The lancet 
is made to plunge entirely through the vein, and into the ar- 
tery; thus establishing an unnatural communication between 
the vessels; which may be either direct, from one to the other, 
or indirect, through a sac formed by effused blood in the eel- 



300 OF MOTHER-SPOTS. 

lular tissue between the artery and vein; both these vessels- 
cpmmunicating freely with the sac. 

This accident is certainly a great misfortune, not only to the 
patient, but also to the operator, for the latter is generally ru- 
ined in reputation: a consequence which is not always just; for 
the accident may occur to the most skilful bleeder, when it is 
absolutely necessary to apply the lancet to a vein which lies 
immediately over an artery. In most cases, however, the oc- 
currence is due to an unusual distribution of the artery of the 
arm, which the operator has the carelessness not to perceive. 
The fact that the artery is wounded, may be known by the blood 
flowing in jets instead of a stead}- stream, and by its very bright 
colour. Some individuals in very high fevers bleed di: 
from the veins by jets, but the blood is then of a darker 
colour. When this accident occurs, the hemorrhage ii 
strained with some difficulty by the ban ernal 

orifice generally closes, leaving the blood escaping from the 
artery to flow back by the vein; which latter vessel becomes 
gradually dilated from the elbow to the shoulder, fornr 
large pulsating tumour at the site of the wound, and communi- 
cating a pecui lion of thrilling along the whole route 
of the vein. The use of the arm is commonly lost. 

A severe and often tedious surgical operation furnishes the 
only means of relief in this affection. 

Mother-spots, ilncurisms from anax/omosh. We often ob- 
serve on the persons of young infants, a few red lines branch- 
ing out from a common centre or interlacing with each c 
which have been compared by nurses to spi 
blackberries, crabs, &c, according to certain superstitious 
judices existing among the vulgar. Though marks somewhat 
similar may be occasioned by mere slight discoloration* of the 
skin, yet a vast majority of them arc formed bv cnla: . 
of capillary vessels; and although a few verv small >; 
may be found to remain permanently, during life, without pro- 
ducing material inconvenient . ptions it 
will be found that the disease extends itself to all the surround- 
ing capillaries, which soon form a slightly pulsating tunn 
a bright red or bluish colour, supplied with bio 
multitude of small arteries which enter it or 
tumour soon penetrates deeply below the skin, and ad me til 
intersects much larger blood vessels. Its growth is, in i 
cases, rather slow, and in others extremely rapid; but, sooner 
or later, the surface ulcerates, the vessels open, and 
hemorrhagesoccurfrom time to time until thepatie 
is exhausted, and if nothing is done to prevent the pi 
the disease, he dies. These tumours may occur on almost any 
part of the body. The scalp, , the breast, the 1 
and the extremities may all be affected; and sometime 



OP MOTHER-SPOTS. 301 

tumours occur In the same patient. Some of the most rapid 
and fatal ones are found on the inside of the under lip; where 
they arc generally of a blue colour, and roll the lip outward 
toward the chin. Sometimes, but rarely, the disease com- 
mences after the patient has arrived at maturity: it is common- 
ly a disease of childhood, and is generally congenital. 

It is of the utmost importance that the best surgical advice 
should be sought immediately in cases of this nature, as a little 
delay may place the disease even beyond the reach of the knife; 
no matter how young and tender the patient may be, if the 
tumour display any tendency to increase in size, it must be 
taken in hand at once. Sometimes, when the tumour is seated 
on the scalp, the breast bone, or any other very firm part, it 
may be cured by methodical j with a compress and 

bandage; especially if the patie years of age. The 

contents of the enlarge-' ' being expressed and prevented 

from returning, the vessels become permanently contracted, 
and the tumour shrivels up and disappears. In other * 
there are no remedies but the knife or ligature. When the 
knife is employed, the hemorrhage is tremendous during the 
cutting, and, if the tumour be large, the life of the patient is 
threatened. The bleeding arteries are so numerous that it is 
impossible to tie them as we proceed, as is done in most ope- 
rations; but the blood ) flow chiefly from the side of 
the cut next the tumour; for i< markablc fact thai, in 
most cases, the moment the excision of the tumour is com- 
pleted the hemorrhage , and there often 
remain but fc requiring the ligature. The operation 
should therefore be performed with rapidity. 

The dangers of the knife may be avoided in some cases oc- 
curring in young children, by a method which, we believe, is 
claimed by Dr. John Khea 15arton,of Philadelphia. 'I 1 wo hare- 
lip pins may be plunged in opposite directions beneath the base 
of the tumour, and left projecting at each end, above the skin. 
A strong ligature being twisted around the four extremities of 
the pins, must then be drawn tight enough to arrest the circu- 
lation in the tumour. If the swelling be very large, this liga- 
ture may require to be re-tightened a little from time to time, 
and in a few days, the tumour will fall off. The only objec- 
tions to this mode of treatment arc, first; that the action of the 
ligature upon the skin is sometimes, though not always, very 
painful; and secondly, that it is often difficult to pass the pins 
entirely beneath the base of the tumour and to bring them 
again to the surface. The first of these objections is at once 
outweighed by the security of the operation, when it is prac 
ticablc; but the second will compel the surgeon to avoid this 
method in cases of the nature just mentioned; for the conse- 



302 OF HERNIA. 

quences of removing a portion only, by means of the ligature, 
might prove not merely dangerous, but even fatal. The pa- 
tient might bleed to death from the remains of the tumour, 
after the ligature has ulcerated off. 

Hernia or Rupture. This dangerous and very common 
disease deserves especial notice in a popular work; because, 
even in this country, where it is supposed to be much less 
common than in some parts of Europe, it probably affects 
every eighth or tenth individual. 

The walls of the abdomen, where they are formed of ten- 
dons, are provided with certain passages designed to transmit 
blood vessels or other parts. Th< ^es are not posi- 

tively open canals, for the coats of the vessels which they 
transmit are connected with the walls of the passages all around, 
by a loose and extensible cellular tissue. The pressure of the 
abdominal muscles upon the bowels, in jumping, lifting, sud- 
den falls, and all violent exertions of the body, sometimes force 
a portion of some bowel outward through the pas This 

accident constitutes hernia or rupture. The bowel al ■•■ 
thrusts before it the peritoneal lining of the abdomen, in the 
form of a sac, within which the bowel lies. The sac tears 
away the loose cellular tissue of the passage, and stretches 
tendinous fibres which surround its outlet. The whole hernia 
then enlarges into a soft or doughy tumour, according to the 
nature of its contents, lying beneath the skin and superficial 
fascia. For some months after the first Appearance of this tu- 
mour, its contents often return into the abdomen when the pa- 
tient lies down, and it then disappears entirely. Bui 
exertion, when standing, tends to force more bowel into the 
it will soon require some effort with the hands of the patient or 
an assistant to restore the protruded bowel to the proper 
ty. This operation is called taxis: and, after t!. uion, 

the hernia is said to be reduced. Hie sac soon forms adhe- 
sions with the surrounding parts in its new situation, and can- 
not be returned; it is then said to be irreducible; but this alone, 
does not prevent the restoration of the bowel. In old i 
the sac is found to undergo, together with the cellular I 
and fascia which cover it, those changes produced by hyper- 
nutrition described at the head of this section, (p. 2S6.) until it is 
sometimes so thickened as to form a very inconvenient tumour, 
even without its contents. The bowels now form adhesions 
to the sac, in some cases, so that they cannot be returned into 
the abdomen. The patient is then said to labour under I 
ducible hernia. At all su n from the first occurrence 

of the accident, a portion of bowel is liable to be forced down, 
so large as to»occasion the tendinous orifice of the canal to bind 
the protruded parts like a cord : causing them to inflame and 






OF HERNIA. 



303 



swell; and if the parts are not reduced, this inflammation so 
increases the firmness of the stricture, that the circulation is 
arrested, and the bowel becomes mortified. When this stric- 
ture occurs, the hernia is said to be strangulated. 

The accompanying drawing (fig. 28,) will give the reader a 
tolerably accurate idea of the several positions in which her- 
nia usually appears. The figure represents the abdomen and 
thighs of a man with the skin on one side chiefly dissected off 
to show the abdominal tendons, and the situation of the prin- 
cipal canals. 

Fig. 28. 

a, b, represents 
the inguinal canal, 
left for the passage 
of the spermatic 
cord, which is 
marked out by two 
dotted lines, and is 
afterwards seen de- 
scending into the 
scrotum. The cord, 
while in the canal, 
and the canal itself, 
are covered by the 
thick tendon of one 
of the great mus- 
cles of the abdo- 
men, and, over that, 
by a fascia, cellular 
membrane and skin. 
a, marks a littledot- 
ted circle which is 
called the internal abdominal ring. This is formed in a fas- 
cia which coven the peritoneum, beneath the abdominal mus- 
cles and tendons. It is the internal orifice of the canal, b, is 
the external abdominal ring, which is formed by a parting of 
the fibres of the tendon of the great muscle which covers the 
canal, and is situated just at the bony edge of the pelvis, g. 
It is the external outlet of the canal, and lies beneath the su- 
perficial fascia, cellular membrane, and skin. These parts are 
the most common locations of hernia in men. Sometimes the 
bowel presses the sac of peritoneum through the internal 
ring, «, into the canal. The accident is then called common 
inguinal hernia. It may happen that the bowel, following 
the route of the canal, does not reach the external ring, so as 
•to rise in front of the tendon. It is then termed concealed 




JUi OF HERNIA. 

inguinal hernia. Sometimes the bowel, covered by the pe- 
ritoneum, bursts up directly through the internal fascia, by 
tearing it, and escapes at once through the internal ril 
without passing through the canal at all. This case is called 
ventro-inguinal hernia. In old cases of common inguinal her- 
nia, the bowel enlarges both rings: drawing the upper one 
down until they nearly correspond, and the canal is destroyed 
or rendered perpendicular to the surface. This accident is 
called direct hernia. In any of these forms, the progress of 
the disease may cause such an elongation of the sac as will 
permit the bowel to fall into the scrotum, which, at last, may 
become so much dilated as to hang nearly to the knee and con- 
tain the greater part of the contents of the abdomen. Incre- 
dible as it appears, even the liver, the spleen, the bladder, and 
the womb, have been occasionally found in hen. 

The line, g, e,f % rcj, he folded edge-of the great 

don which marks the upper boundary of t! 
be felt stretching from near the pubis to the ; i ominent 

point of the side of the pelvis. Just below . marks the 

spot where the tumour generally appears in femoral hernia; 
said to be the most common \ I women. The canal 

by which this hernia ei that which g to the 

great blood v< "he se- 

phena vein plunging down to t vein of the thigh be- 

neath, and will give a tolerable idea of the position of 1 
nal, which lies high up under the fold of tendon g % e.f. — d, de- 
signates the umbilicus; where the v to and coming 
from the after-birth, enter and pass out of the foe- 
tus before birth. The parts around the scar formed by the 
Killing o(T of the * er quite so firmly pre 
tendon as those at a 1! t distance; and hence this 
becomes the seat of a kind of hernia called umbiiiea 
which is more common in women than in men. 

By kick . tunds, and other acci me- 

times by the growth o( fatty tumours between the fibres, the 
tendons may be torn or pat 1 the bo . protrude 

at almost any point on the 

do men, constituting ventral hernia. These, and certain in:. 
varieties which are very rare, require h cal skill, and 

need not be described in a popular work. 

Symptoms and com of strangulation, h 

hernial patient i^ constant); tion, 

and every one who labours under strangulated hernia 
considerable danger of death, — the symptom 
extent, the treatment, should be known to al!. 
occurrence, strangulation is generally mistaken for colic; 
pt in the severity of the pain at the ring, the \ 



.SYMPTOMS AND CONSEQUENCES OF STKANGULATION. 305 

symptoms, for some time, scarcely differ from those of a very 
bad colic. Almost invariably, there is one loose discharge from 
the bowels near the moment of strangulation; it is even vio- 
lent and copious, in some instances; and occasionally, but very 
rarely, a second follows very soon after. This seems asto- 
nishing; as, in most strangulated hernia}, the whole calibre of 
some part of the intestine is so tightly grasped by the ring, 
that nothing can possibly pass: but in fact, these evacuations 
come exclusively from the part of the alimentary canal below 
the stricture; and this portion once evacuated, all farther pas- 
sages are impossible until the strangulation is relieved. The 
exceptions to this rule are exceedingly rare; for even when 
the tight ring embraces only a portion of the calibre of a large 
gut, or when it grasps the caul or omentum without any por- 
tion of the intestinal canal, the extreme irritation produced, 
almost always occasions a spasmodic stricture of some part of 
the gut, which completely closes its passage; and the spasm 
will continue, if the omentum be not reduced, until the pa- 
tient dies. Still there are some exceptions. I have known a 
large piece of omentum, strangulated in the common inguinal 
hernia of a young female, to mortify and be thrown out by ab- 
scess, while the patient continued to have daily discharges, 
though suffering severely with colic pains. 

Soon after ti gulation occurs, the hernial tumour be- 

comes tender to the touch, and commences to swell, severe 
pains ire usually felt both at the scat of stricture and about 
the umbilicus, the latter being often more distinctly paroxys- 
mal. As the case advances, it* left to run it <•, the tu- 
mour increases in 1. purple, and 
livid, while its tenderness becomes continually more marked, 
and is extended to the abdomen, so that the patient can scarcely 
bear to be touched on any pari of its surface. Contempora- 
neously with these local changes, the countenance assumes 
first an anxious, then a haggard expression; the pulse rises 
and becomes very frequent, then diminishes in volume and 
becomes gradually more and more feeble and fluttering; while 
tomach is affected in succession with nausea, vomiting, 
hiccough, and finally the discharge by mouth, of fecal matter. 

In protracted eases; — those for instance which have continued 
from four to eight days; — it is usual for the symptoms, when at 
their point of greatest severity, to cease suddenly and entirely 
without any return of the bowel, leaving the patient calm and 
{vec from pain. This flattering condition of things is the im- 
mediate precursor of death. It marks the moment when the 
mass of intestines inflamed by the accident sink into a state 
of mortification. 

39 



306 OPERATION FOR HERNIA. 

It has been alrtady remarked that when nothing but omen- 
tum is embraced in the stricture, the contents of the sac may 
mortify and come away without destroying the patient. The 
same thing may happen even when the sac contains mortified 
intestine, provided the stricture be relieved and the dead bow- 
el laid open in time by a surgical operation. When thifl 
suit takes place, all feces are discharged by the wound, and 
the patient is said to labour under artificial anus: 

The continuance of life under such circumstances dep 
mainly upon the spot where the intestine is laid open. If 
there be length enough above this spot to allow the absorbents 
or lacteals to take up the greater part of the nourishment con- 
tained in the food, the patient lives; but if the opening be much 
nearer the stomach, he dies of gradual starvation! The con- 
dition of a patient with artificial anus would be such as to ren- 
der life undesirable, were it not that means have been d 

■! to enable the surgeon to re-establish the route of the in- 
testine by creating a lateral passage from one extremity of the 
intestine, at the wound, into the o! inity. i 

first accomplished by DOT distinguished countryman, the 
Dr. Physic k, snd h ^swasrcL 

est triumphs of the art. The late M. Dupuytren, of I 
Dicu, soon afterwards contrived another method of operating 
for the same purpose; hut a Dr. Lotz, a country practitioner 
residing in one of the interior counties of Pen. . has, 

by a very happy thought, succeeded in contriving 
fully employing an instrument wh more 

usefulness than the plans of either of i: surgeons just 

mentioned. Some very ran- esses of artificial I 
ble without an operation with the knife; but a description of 
them would detain us too long. The domestic practitioner 
can do nothing with - 

On the removal rtf stran gula tion by the knij ope- 

ration for hernia, as it is called, consists in making a lor. _ 
cision through th mmencing an inch or two above the 

neck of the sac, and c\tcr.< lal inches below the neck, 

along the front perl of the tumour. The cellular membrane, 
and any layers of hich may chance to lie over the sac 

after it has escaped through the tendinous canal, are then di- 
vided to somewhat less extent; and, the sac being laid bare. 
some surgeons lay it open and i I 

ing which others - ua/, both pa 

arc right, and merely rtai t: but the 

argument belongs exclusively to I . and mu> 

be opened here. 

The sac being laid bare or open, — may be. the - 



OPERATION FOR HERNIA. 307 

geon then thrusts his fore-finger into the tendinous canal as 
for M the edge of the stricture which binds the bowel and neck 
of the sac. Then, taking; a narrow, blunt-pointed knife, he 
lays it flat along the finger, and pushes it past the stricture — 
entirely into the abdomen if necessary; — and, having entered 
far enough, he turns the edge up, and divides a few fibres of the 
strictm in jj; tendon or fascia, in swell a direction as to endanger 
least the neighbouring arteries. The bowel is then easily re- 
duced. This is an operation which, varied according to the 
kind of hernia, has excited more dispute and discussion in the 
profession khan its importance d md in 

ninety-nine cases in the hiw ned by a tole- 

rable anatomist who has not been i">» much confused by reed" 

! complexity where no eompi its, li is not at 

ail dai in its own nature, of ad- 

Di between the 1 . PO old and firm as 

to prevent a pi from distinguishing between them. 

true that in opening the tee, the knife has been known 
to burst into a mortified in! but the sooner Mich an ac- 

cident happens, ii cmn happen^ the better for the patient. 

Ac to find on record a case of death from the 
simple effect of the operation for strangulated hernia; yet it is 
not entirely without its ten ung practitioners; for there 

A formidable accidents which occasionally happen 
during or after ti lion, to which all are alike liable 

ikilfal or d op- 

portunity | n to ruin a 1 g by s 

_ of the >houlder; and the public should be upon its guard 
ich interested pi which are nut wholly un- 

known even in t;, .1 of professions, 

It will i er makii Jit of an operation 

lered among, the most da. \ how it happens that so 

a portion of the p ited upon, die within a few 

iformanccl The Though the 

operation for hernia is not dangerous, yet the complete- stran- 
gulation of a bowel even fur a tew boil eedingly dan- 
Lnding law of the profession that the knife 
should not be employed until all other reasonable means of re- 
duction b tried and failed. The operation is scarcely 
ever performed in less than twelve hours after strangulation; 
seldom, in less than twenty-four hours; and not very un fre- 
quently, at still later period*. The j^easonuljle measure* to 
which the bowel is subjected during these intervals, will be 
clear to the reader after our remarks on reduction. They are 
such that if the stricture be not pretty nearly complete, they 
must restore the bowel; and the patient almost always reco- 



308 DEDUCTION OF HERNIA BY TAXIS. 

vers, if this be effected in a very few hours: though even the 
partial pinching, in more protracted cases, sometimes brings on 
inflammation and death after reduction. Now it is clear that 
the cases operated on at twelve, twenty-four, thirty-six hours, 
&c, are generally cases of nearly complete, and sometime 
quite complete strangulation of twelve, twenty-four, &c. hours* 
duration. It is impossible that a complete strangulation, (i. e. 
one which arrests the circulation,) could continue for even six 
hours without producing the destruction of the life of the 
el. It is even very singular that a nearly perfect stricture 
should exist twelve hours or longer, without producii 
least a fatal inflammation of the strictured part. The reader 
may now judge how little the operation has to do with the 
death which so often follows. 

Dozens of lives have been and still continue to be sacrificed 
by the delay of this operation, from idle fears, which might 
be saved by a little more promptitude in performing it. 

Treatment of strangulation Inj tau ction. The 

moment strangulation occurs, a good surgeon should be sent 
for, if possible; but as this is not always the case, not a mo- 
ment should be lot (I iends, in attempt- 
ing reduction before the arrival of I The pal 
should undress, and lie on his back in bed. The affected part 
should be thoroughly shaved. If the hernia be not extremely 
large, and old or irreducible in its character, the following 
course should be pursued. The head and shoulders, as well as 
the pelvis, should be strongly i The thighs 
should be completely bent, and the heels drawn up high in bed. 
If the hernia should be located in the groin, the thigh on the 
affected side should be most elevated, and should also be car- 
ried a little across its fellow. The patient should now 
dily endeavour to return the bowel by the D which he 
may have found generally - I in his own ease. Tl 
efforts may be continued for half an hour; when, if ineffectual, 
and if no surgeon have been procured, other B 
be pursued by a highly intelligent assistant. The patient, if 
vigorous, may be freely bled from the arm, and the cl 
local applications may be made. When ice cannot be procured, 
the powder of muriate of ammonia thrown into water, may be 
used, to produce intense cold. Whatever article is employed, it 
should bo done faithfully: the only precaution i 
avoid the actual freezing of the tumour. While this cold is 
being applied, it is sometimes useful to place one or two heavy 
smoothing irons upon the hernia; lor we have repeatedly 
the reduction happily effected under the steady pressu: 
such instruments, without the aid of ha: ouioe 



RETENTION OF IIEUNIA BY TRUSSES. 309 

the cold for full half an hour, the patient or assistant should 
again attempt the reduction. If still unsuccessful, the cold 
should be continued; and if there be much disposition to in- 
flammation about the part, leeches may be applied over or 
round the neck of the sac. A powerful injection of senna 
tea and salts, will sometimes do essential service by calling 
strongly into play the peristaltic action of the lower part of 
the alimentary canal; and the smallest escape of feces from 
the strictured bowel will often pave the way for the reduction 
of large and obstinately strictured hernia:. The taxis should 
be renewed every half hour; and great care must be taken to 
act steadily, regularly, and patiently, covering as much as pos- 
sible of the tumour with the hands, and avoiding any severe 
i|)on one spot. The kneading, punching, ami violent 
thrusting frequently resorted to by I and inexperienced 

practitioti' \tremely da: tg nd may deploy th< 

tienteven after the reduction it accomplished With apparent suc- 
The direction of the pressure may be changed a little from 
side to side to advantage, and requires to be varied with the 
kind of hernia, and its route of escape* Details on this sub- 
ject cannot be given here, but we would J advise I 
director of a large manufactory, mining concern, or planta- 
tion, as well as every preceptor of a boarding school, to make 
himself somewhat acquainted with the anatomy of the ingui- 
nal femoral canals, in order to become more capable of 

dness to those under his control, o the 

ting room, with a small fee to th r. would put 

him in possession of the desired information. We might con- 
tinue the subject of redaction through much -pace, 
tC mention the very numerous ten ■ommend- 
edj ami occasionally i mployed, by various practitioners; but it 
is believed that the directions already given, are all that can 
be at once safely and usefully followed by the domestic prac- 
titioner. 

It may be well, however, to remark that strangulation in 
very old or irreducible hernia?, is less frequently attended with 
fatal consequences. Spontaneous reduction not unfrcquently 

place in large old hernia: alter strangulation has e\ 
for several days. Where- the local inflammation in ti 
is not vci . in addition to measures in aid of texts, 

as recommended above, the best effects often result from giving 
an active purge of oil or senna; remedies which might be very 
dangerous in more recent 

Retention <>f hernia by trusses — Radical cure. The truss, 
and its use in retaining the bowel in hernia, are too well known 
to require particular description, lint the proper construe- 



310 RADICAL CURE OF HERNIA BY TRl 

tion of trusses has been shamefully neglected, until recently,, 
by the profession; being thrown entirely into the hands of in- 
strument-makers and pretenders, whose continual changes, and 
improvements, — so called, — have rendered it difficult to num- 
ber the modifications: yet until within the last three or four 
years, no instrument had been invented equal in usefulness to 
the old-fashioned common truss invented before any of them. 
None of the trusses invented before the year 1S34, were en- 
tirely dependable in retaining even the common inguinal her- 
nia completely and permanently. The bowel would occasion- 
ally descend, in defiance of the care of the patient, and the 
truss itself became a source of danger by its action on the 
bowel. Humanity is indebted to Dr. Hebe: of Phila- 

delphia, for the invention of a complete series of trusses adapted 
to each variety of hernia, and all the complications of several 
varieties occurring in the same individual; whi.ch instruments, 
after they are once properly adjusted, are capable of retaining 
the bowel with absolute certainty, under all the exertions re- 
quired even by laborious prol 

But this ii not all — It is found that this certainty and per- 
fection of retention enables the pt i.ature to contract 
the passage in the mam ribed at I of this sec- 
tion, (p. 285,) so that after the tru^> has been worn from nine to 
eighteen months, the patient generally finds himself radically 
cured. Wc believe that this result will take place in no: 
than nine-tenths of the cases occurring in persons under fifty 
years of age, and in ■ fair proportion of cases later in life. 

One of the principal operativ as of Philadelphia, re- 

marks that the number of cases of strangulated hernia h. 
minished astonishingly since the introduction of these instru- 
ments. 

Unfortunately, they positively require to be adjusted and 
applied in the first instance, by | on who has taken the 

pains to study their use and construction — and as such a 
one is not always procurable, it will be frequently i 
to resort, temporarily, to other com :i recom- 

mend none better than a broad, firm bandage round the b 
and a thick compress over the navel, in umbilical hernia; the 
old-fashioned common truss in inguinal hernia: and in femo- 
ral hernia, wc scarcely know what to recommend. A 
of a number of ordinary trusses may perhaps enable the pa- 
tient to seize upon one which may support the bowel tole- 
rably well, but no instrument expressly applicable to 
form of the disease was even in use prior to the inventu 
Or. Chase's femoral truss. This inventor published ■ 
on the radical cure of Hernia by Instruments in 



CURVATURES OF THE SPINE. 311 

replete with information designed for the use of patients and 
popular inquirers, to whose attention we would strongly re- 
commend it. 



SECTION III. 

On Deformities from Imperfect Nutrition of the Osseous 
and Muscular System* 

Under this head wo may treat of two classes of affections 
which demand some notice in a popular woik: namely, curva- 
tures of the spine, and club-f< 

Of curcu tu res of t lie spine. These deformities occur from 
a great variety of C*U8e8, of which a considerable class are 
connected with an exceedingly depraved condition of the con- 
stitution, sometimes scrofulous, sometimes cancerous, some- 
times syphilitic, &c. These difl -lerally result 
from accidental weakness or unfavourable circumstances sur- 
rounding the individual ; occasionally, from hereditary peculi- 
arities of the race ; as in the case of the Cretins; and now 
and then, they plainly fall upon the innocent child, as the bit- 
terest of all tl - of Providence upon the errors of the 
parent. The grave easel to which we allude are Chose which 
produce serious alterations of structure in the bones of the 
■pine, and sometimes the entire destruction of the bodies of 
some of the vertebras. Such cases generally occur in 
childhood; though they ate sometimes produced by accidents 
at an advanced age, in perSOUS of SCTOfuIo llty habit 
This character is recognisable at once, by the severity of the 
inflammatory and febrile symptoms which mark the com- 
mencement of the deformity, and recur frequently during its 
continuance. 

Every thing in the treatment of these terrible affections, 
must be made to depend upon the skill and faithfulness of a 
superior surgeon; for madness only could induce the tamper- 
ing of unprofessional hands with cases of such a character. 
Unfortunately, but very few, even among American surgeons, 
have given particular attention to this subject — partly on ac- 
count of the rarity of the disease in this country, and partly 
because most of the cases occur among those whose extreme 
poverty reduces them to an absolute dependence upon politi- 
cal, or governmental charity; which, boastful as it always is, 
but seldom furnishes the means for a long and expensive 
course of treatment in a chronic disease. Our hospitals, which 
are mostly private charities, reject these protracted cases very 



312 CURVATURES OF THE SPINE. 

properly; because they would occupy a portion of a limited 
space to a disadvantage, and exhaust contracted funds which 
would effect much more good in curing acute and rapid dis- 
eases. 

The practitioner, being thus cut off from the experience 
which might be obtained from the treatment of masses of 
cases in hospitals and alms-houses, necessarily approaches the 
few scattered patients of a richer order, in his private practice, 
without the necessary lights. 

Unfortunately, the indisposition of the profession to grapple 
with these more serious diseases of the spine, has induced a 
neglect, also, of those vastly more numerous and milder curva- 
tures which result simply from relaxation of the ligaments, 
and deficient tonicity of the spinal muscles. 

Of late years, a few practitioners of real merit have given 
much attention to this subject, and the public faith in empi- 
rics and pretenders begins to be on the decline. But the ap- 
paratus which is useful, if not essential, to the proper treat- 
ment of these deformities, when considerably advanced, is 
complex, anil too expensive for the means of private families 
and general practitioners. In Europe, such cases are referred 
to privc institutions called X; — and although an 

unreasonable and groundless pride, too commonly lead- 
aspiring surgeon in this country to avoid confining his atten- 
tion to the treatment of any one special 
under the erroneous idea that such a course is calculated to 
lessen his professional respectability, yet we arc not without 
hopes of seeing Philadelphia provided with a respcetab!- 
ihopedic Institution. Till then, let us lay down the rules 
which may be safely followed by parents an<; 
10g the progress, or in removing the appearand | de- 

formities. 

Curvatures of t lie spine from relaxed ligaments and weak 
muscles, usually occur in your, _ I approaching Lhe _ 

of puberty, and thi number than 

boys. The rich and luxurious are most liable to such curva- 
tures, but they are seen in many oi the children of the poor. 
It is observed that, in a vast majority of cases, the left shoulder 
hangs lower than the right; and in females, the dress habitual- 
ly slips from the former. This is the circumstance which 
first calls attention to the deformity; but it is by no no 
the first in the order of morbid changes. The criminal indul- 
gence of fondness for cakes, sweetmeats, and rich ; 
young and rapidly growing girls, deprives them of their appe- 
tite for animal food, which furnishes the most powerful nou- 
rishment to the muscular system. The otions enter- 
tained among the wealthy, with regard to propriety and e\ 



CURVATURES OF THE SPINE. 313 

rum m female children, cut them off from almost every 
opportunity of giving; active exercise to the muscles, and 
■especially to those of the back, which, therefore, rapidly lose 
their tone, as will all organs when habitually unemployed. As 
if these sources of mischief were not sufficient to render the 
sex sufficiently delicate, or, to speak more correctly, crippled. 
Fashion comes in to the rescue, with her stays and corsets, to 
improve God's image according to her ideas of beauty and 
symmetry. Bound up in steel or hickory, whalebone, and 
firm cloth, the unfortunate spinal muscles have so little chance 
of employment, that too frequently they become shrunken, 
pale, flabby, and dropsical; the same results being also extend- 
ed to the ligaments. There then remains scarcely any sup- 
port to the spine; which, being a long narrow column com- 
posed of twenty-four distinct parts, must bend in some direc- 
tion, if unsupported by mechanical contrivances, the moment 
the body ! - perpendicularity, as it must do even in 

taking a single step. 

The mal-arrangement of habits and attitudes at school, are 
admirably adapted to give the greatest possible effect to these 
causes of deformity. Indeed, it seems to be held essential to 
the proper worship of the Divinity, and the successful prose- 
cution of learning, that the body should be subjected to phy- 
sical torture, to promote the due exercise of the mind — wit- 
ness the perpendicular walls ol" pews, the backless bene! 
lecture rooms, and the isolated stools of our seminaries. The 
human spine cannot he held erect, except by a continued mus- 
cular effort, and no spinal muscle will endure half an hour 
of conslant exertion, without becoming completely exhausted: 
when weakened in the manner above described, it cannot 
act for ten minutes without n If the feeble victim of 

spinal curvature should attempt to relieve herself by reclining, 
during the long and unreasonable sessions of the schools, — her 
seal being unprovided with back or arms, and her right hand 
almost constantly employed with her book or papers, — she 
can only accomplish her purpose by leaning with her left 
elbow upon the desk; and the constant resort to this practice 
increases the deformity of spine, by weakening still more the 
muscles which support the left shoulder, and by producing a 
twisting of the vertebrae, which complicates the curvatures. 
The ill effects of this attitude have been so frequently men- 
tioned in popular works and lectures, that preceptors general- 
ly endeavour to prevent their pupils from assuming it — 

" Don't lean on your desk, Miss ■ ! sit up straight, and 

hold your shoulders back, or you will grow crooked!" — Such 
is the usual order; now look to the consequences! The up- 
right position of the spine being altogether insupportable for 

10 



314 CURVATURES OF THE SPINE. 

more than a few moments, the child endeavours to relieve 
herself by bearing her weight upon one hip; and, as in most 
persons, the right upper extremity, and the left lower extre- 
mity are naturally stronger than their fellows, it is usually 
upon the left hip that the patient sits. This attitude com- 
pels the child to incline her body toward the left side, to 1 
about the proper equilibrium. The weight of the whole up- 
per part of the person then bears upon the inclined lumbar ver- 
tebrae, which are much more moveable than those of the back, 
though they suffer less pressure: consequently, as the weak 
and tired muscles soon cease to give any effective support, the 
former bones tend continually more and more to the left, un- 
til the ligaments which connect them are put upon the stretch, 
and the balance of the person is again destroyed by the weight 
of the head and chest. This o ic sufferer to turn the 

upper part of the person to the right, by voluntary effort* to 
recover the equipoise. The two or three lower lumbar verte- 
brae preserving their inclination to the left, the remainder are 
now brought back toward the middle line; and the lower dor- 
sal vertebrae, being compelled to partake in the same change 
of position, the le rmed into a bow, 

with its convexity looking to the left. When the patient re- 
clines in bed. the bones, for some time after the commence- 
ment of the case, slowly resume their natural position; but 
the daily repetition of the same causes continually incr 
the deformity, until the weight of the head and should' 
thrown too far to the right, and continual efforts are made to 
restore the balance by carrying them again to the left. 1 
the firmly knit dorsal arc forced gradually to j 

to these efforts by the extension of their ligaments, and the 
spine of the hack of the chest is formed into one great bow, 
with its convexity turned to the right. This occasions the 
left shoulder to droop, ind - the right one very promi- 

nent. The ribs on the latter side are separated from each 
other, while those on the former arc made to approach more 
nearly together. A repetition of the same pro- 

duces a similar bending of the spine of the neck, in the oppo- 
site direction, corresponding with that in the lumbar n z 

Such is the history of the formation of the most coir,: 
form of lateral curvature of the spine — a deformity exist i : g 
greater or less in nearly two-thirds of the ft 

refined life. At the commencement the patient can render the 
spine straight for a few mome most immediately the 

body falls, and the curves are reproduced. When the deformity 
continues slight until the patient has reached mat;, 
it generally remains stationary ever aflerw. 

The curva* described being once commci\ 



CUBVATURES OF THE SPINE. 315 

evident that the weight of the body must act as a constant 
force, tending to increase their convexity; and that the irregu-r 
Jar action of the weakened and displaced muscles, must fre- 
quently assist in producing the same evil. From this con- 
stant increase of curvature there results, in certain bad cases, 
a series of changes of a formidable, and sometimes highly 
dangerous character. The ribs on the side corresponding 
with the convexity of the dorsal portion of the spine, are se- 
parated more and more widely from each other, while those 
corresponding with the concavity, are made to touch, or even 
overlap each other; sometimes they even become united by 
bone. The bodies of the vertebras become wedge-shaped bv 
their pressure upon each other, and the position of the 1 
bone is seriously changed. The consequences of these various 
change* of form, acting on I i i and the health, need 

not be dwelt upon; but fortunately, so long as the suspension 
of the body on the arm-. nsion by the shoulders 

and feet, produces any visible diminution of the curves or 
lengthening of the body, the case remains, in a great degree, 
or wholly curable — and if the attack have not been preceded 
by fever or much local pain in the spine, a great deal of good 
may be done by the domestic practitioner, in the absence of 
more scientific ad\ 

—The indications to be fulfilled in the domestic 
management of these . Brat, I the whole 

omlly, to 
the bulk and strength of the muscles of the spine bv 
. local applications and repc 

I ried to such an extent as to produce 
exhaustion. The debility of the patient will of; r her 

table of (Talking any considerable distance; and the pas- 
f riding, with the more active amusements of 
bathing and swimming, if ladies may be supposed to swim in 
America as they do in Europe, are among the most beneficial 
efforts. The patient should never be permitted to sit, with- 
iilicient supports on every side, to be used when desired. 
A cushioned and armed rocking chair, with a sloping back, (not 
concave longitudinally.) is most convenient on ordinary oc- 
casions, ami a similar chair without rockers, while pursuing 
studies. As the time spent in the study and the carriage cannot 
be employed in exercising usefully the muscles of the spine, it 
is best that they should then be kept in as perfect repose as pos- 
sible; and this is best effected by a well made corset, calcu- 
lated to support the figure as nearly in the natural position 
as possible. 

The use of tonics must be managed with some caution, and 



316 CURVATURES OF THE SPINE. 

whenever febrile symptoms appear during their employment, 
they must be omitted for a time. The prescription which we 
have found most generally efficacious, is as follows: — Direct 
the patient to take a dose of five drops of the muriated tinc- 
ture of iron, in a wine-glass half full of water, on the morn- 
ing and evening of alternate days; and on the intermediate 
days, let her take a wine-glassful of a mild infusion of gentian, 
columbo, or quassia, on an empty stomach, twenty minutes 
or more before each meal. If the remedies occasion costive- 
ness, this may he corrected by an occasional Seidlitz powder. 
The muriated tincture of iron appears to have a peculiar e 
in giving firmness and colour to muscular fibre. 

The diet best calculated to increase the bulk and tone of 
the muscular system, is one composed chiefly of the flesh of 
full grown animals; such as beef, venison, wild ^nme, mutton,. 
fltc., but especially beef. The meat is I 
on the gridiron, and dl I plainly and 

of the patient will allow. Some have, unlbrtui. 
dislike to beef, and it is nc< avoid pi 

IDg patients to partake of what is decidedly disagreeable ei- 
ther in kind or quantity. Pork is inadmissable in all forms. 

Local applications to increase the tonicity of the spinal 
muscles, often produce very important effect* 
in the morning and after retiring for the night, th ould 

be well rubbed from end to end with a flesh brush; for which 
may be substituted, every three or four days, frictions with a 
rough towel, wet with a saturated warm brine: care being 
taken to dry the back perfectly, after the operation, and to l 
the patient strictly against cold. Extending the application 
of the flesh brush in a more gentle manner to the rest of the 
surface is often very beneficial. 

But the most important and difficult part of the treatment 
is the graduated i mil repose of the spinal mu* 

The use of an organ without over-tasking its actual power, in- 
creases iis strength ai. itiguing an ( 
quentlv, we weaken it. The incn _h. and actual 
growth of an organ, under . do not take place during 
the exertion, but afterwards; and they arc much promok 
absolute repose in the intervals of exertion. 

The exercise of the spinal muscles, while the weight of the 
person is pressing down on the spinal column in a stale of con- 
siderable curvature, is calculated to increase the c id re- 
pose, however absolute, in the upright position, is also calcu- 
lated to increase the evil. Such are the principles which should 
guide us in our practice. 

Let a suitable dry garret or chamber be - where a 

fire may be lighted when required. Into one of tin 



CURVATURES OF THE SPINE. 317 

beams of the ceiling, secure very firmly an iron staple, from 
which suspend a rope terminating in a ring or eye, a little 
above the height of the palm of the patient's hands when held 
up as high as possible while standing on tip-toe. In this ring, 
secure crosswise a round wooden slick, two feet six inches 
long and one inch thick. Cover both ends of this stick with 
buckskin. On the floor immediately under the suspended 
rope, place a light stepping block, nine inches square and four 
inches thick. The apparatus is then ready for use. 

in hour after bre tl every evening, 

two hours after dinner, the young lady. u I, should 

step upon the block, and seizil Slick with her 

the block a tew inches to one side with 
.villi her toes upon th The exercises 

it, at first, part or the whole of the weight 

of the body by the arms, according to the strength of the pa- 
tient. This is done at once by simply bending the k 
The weight of the pelvis ami lower limbs then acts as an ex- 
tending force, and strai I and lumbar curvatures 
of the spine. At first, the debility of the patient will often 
put a stop to i :i in half a minute; but when I 
tomed to the l will be able to continue it for I: i 
ten minutes at a time. When the arms and anl 
the lb fled with the tip of the to 

itient m pari of her 

t upon the c When sufficiently rested, the 

1, but it must never be carried so 
s to lead to j . ie. 

r the patient has acquire I h sufficient to support 

ight f«>r some moments, without touching the 

floor with her ml co- 

ly throwing the pelvis and 
limbs backward and forward, and also from side to side, all the 
l of the back of the spine will be called into active ex- 
ertion in a manner calculated to increase their power, while 
the curvatures are undergoing an actual extension. These cx- 
s may be continued longer and longer from week to week, 
and must be pursued steadily 1 1 months, before much 

permanent benefit can be expected. 

The moment the exercise is finished, the patient should be 
conveyed to bed; a good feather bed, not too thick, and laid 
on a well tightened sacking, being preferable to a mattress. 
1 'here she should repose upon her back for one or two hours, 
according to her degree of feebleness. The corset may then 
be applied, and she may be permitted to rise. 

When the patient has so far recovered by the general and 
local treatment above recommended, that the curvature of the 



318 HAE1T OF STRAINING. 

back is but slightly perceptible, she may take part to adran~ 
tage in active exercises and amusements without suspension, 
and among the most useful of these are the plays of battle- 
door and shuttle-cock, and the graces. The former should 
be played chiefly with the left hand. Dancing, jumping the 
rope, and the oft prescribed but highly injurious exertions 
of waxing furniture, and making beds, should be scrupulously 
avoided until the increased age of the patient assures us that 
the existing condition of the spine has become permanent. 
Nearly all cases of the kind under consideration are curable 
if undertaken before the age of seventeen, and most of them, 
if bad, remain nearly unchangeable after the age of twenty. 

Before quitting entirely the subject of curvature of the spine, 
it is right to mention that it is very common, for both young; 
ladies and young gentlemen, to contract a habit of bending the 
head and shoulders habitually forward, until tire back becomes 
arched, the shoulders rounded, and the head has a confirmed 
stoop. This exceedingly ungraceful defect is often i 
worse by the means used to eun tiff collars, and Mi- 

nerva braces; which, by relaxing the muscles of the back, cause 
the spine to be much more arched, the moment they are re- 
moved. This defect of figun J corrected by fitting to the 
head a cap with a long cord attached to its front margin, which 
may be passed over a pulley attached to the door or mantel- 
piece at about the height of the pat freight I 
veral pounds being fixed at its extremity, the patient, while sit- 
ting or standing, amuses himself in drawing the weight up and 
down, by causing his head alternately to advance toward, and 
retreat from the pulley. Another method consists in wearing 
a cap or calash with a padded crown, ami reclining repea: 
everyday, for as long a time as possible, with the back of the 
head against the wall anil the feet thrust forward one. two, or 
three feet upon the floor, according to the strength of the pa- 
tient. This inclined position o( the person causes the weight of 
the body to rest upon the back of the head and feet alone, ami 
the extending muscles of the spine must exert themselves pow- 
erfully to prevent the patient from sinking toward the floor, 
which exercise rapidly increases the!; h. Rov 
working with the cross-cut saw. climbing hand over hand, 
are athletic occupations well calculated to cure the most obsti- 
nate stoop. 

Of Club-foot. We shall say but a few words on this | 
ject, for it is doubtful whether any degree of ingenuity in the 
domestic practitioner will enable him to be useful in the treat- 
ment of the deformity. Vet as most cases are curable if taken 
in hand before the children are five years old. It would be wrong 
to let the occasion pass without impressing 00 parents tlu 



OF FRACTURES. 319 

cessity of seeking good surgical advice in time; cautioning them, 
at the same time, against the boasts of mere instrument ma- 
kers and empirics. 

In club-loot, the bones of the leg are sometimes defective 
in form, one or the other being too short at the point, or they 
are dislocated from each other before birth, the outer ankle 
bone (fibular malleolus) sliding behind the great bone of the 
leg, (tibia.) These accidents sometimes give rise to the com- 
mencement of club-feet, but in many cases the ankle joint, 
properly so called, is very little disturbed, and the chief amount 
of change takes place by the twisting and overturning of the 
bone of the heel, and a revolution among the bones forming the 
articulation which rims across the instep. In most cases, the 
outer edge of the foot tends to rest on the ground; the instep 
looks outwards and the sole inward, while the toes are drawn 
upward; and, in many instances, their backs may be laid, by the 
hand of the nurse, straight up along the leg! Sometimes, but 
very rarely, the deformity is in the opposite direction, and the 
foot rests upon its inner edge. Again, not unfrequently. the 
heel is drawn forcibly upward, and the toes pointed downward 
so that the patient walks on the latter, and the former can ne- 
ver approach the ground. 

Now as scarcely any two cai in the nature and ex- 

tent of the deformity, which frequently extends even to the 
knee and hip joints, it follows that the forces required to re- 
store the bones to their places must be almot ioua in di- 
rection as the • in number; hence it would be folly to 
place the treatment in unprofessional hands; but as nearly i 
case is curable if taken in time, it would be criminal to Buffer 
the deformity to be neglected, even during the first months of 
infancy, when surgical advice is accessible. 



section iv. 



Of Fractures. 

Our remarks on fractures must necessarily be general; for in 
a small portion only of these accidents can an unprofessional 
person safely undertake the treatment, even in the absence of 
a surgeon; yet, as there are many ways in which such as 
ants may be useful in promoting the welfare of the patient 
when no surgeon can be obtained, some little history of frac- 
tures, and a few special directions for the management of 
such accidents, are deemed proper in this place. 

It is a very popular prejudice that much depends, in frac- 
tures, upon the first setting of the bones; and it is not uncom- 



320 or FRACTURES. 

mon when one practitioner has wound himself into the care 
of a case belonging originally to some younger but better in- 
formed surgeon; (adishonourable trick which we have seen more 
than once performed in country practice by those who, like a 
certain venerable friend of ours, have founded forty years of 
lucrative practice on no better diploma than an old title deed 
of land, written in Latin, and on parchment in olden times;) it 
is not uncommon, we say, under such circumstances, for the em- 
piric to charge deformity arising from his own want of skill to 
the careless setting of the regular practitioner at the commence- 
ment. Now be it known that extreme accuracy of the first, 
ay! and the second, and third settings of a fracture, (for most 
cases require many re-settings.) is a matter of comparatively 
little importance! In fractures near a joint, indeed, great care 
and accuracy may be required at the very first; for the swell- 
ing produced by the accident is very apt to destroy all after- 
chance of action until too late : but these cases form a vcry 
small minority among fractures, nine-tenths of which proba- 
bly occur somewhere near the middle of a long bone. 

Let us not be misunderstood — It is of the utmost import- 
ance, in fractures of the extremities, that we should brin_ 
limb to its full length as soon >le after the accident, 

and keep it so; for every hour of overlapping between the : 
ments permits of a more and more obstinate contraction of 
the muscles, which always struggle to shorten the limb, 
oppose the correct setting. The overlapping, if permitted to 
continue for some days, produi all the surround- 

ing parts, preparatory toe fleeting a union of the fragmei 
their false position; and when those fragment! arc alterv 
drawn nearer to their proper pi - arc rend 

useless, and new or.es are demandc the cure of a frac- 

ture is always a serious tax on the powers of the system, and 
this needless additional taxation of these powers endangers the 
production of a weak bond of union, or a false joint. But if 
the limb be of a full length, a little sliding of a fragment 
to the right or left, or even a considerable angular de- 
formity at the seat of fracture, is of scarce any importance 
until after the expiration of two weeks. The whole of this 
period is occupied by nature in swelling and developing the 
periosteum for many inches above and below the fraetur 
distending its cells with effused fluids, to permit its little 
sels to expand freely and carry red blood; in filling the cells 
of the surrounding cellular tissue and expanding Is in 

the same manner; in absorbing the medullary matter from 
flie ends of the fragments, the colouring matter from the 
coagllla formed by the accident; and in forming little canals 
through the latter, to permit of the growth of cellular tissue 



FRACTURES OF THE CLAVICLE. 321 

to act on their interior. After all this is done, say from the 
end of the second to the middle of the third week, the blood 
vessels begin to fill the cells of all this mass of prepared tis- 
sue, first with a substance resembling cartilage, and then with 
bony matter. It now becomes truly important to set the 
limb with accuracy, and to keep it perfectly motionless until 
firmly united. In about five or six weeks in young, healthy, 
and sanguine patients, and in from nine to twelve, in old, 
phlegmatic, or intemperate people, a broken bone will he found 
firmly united by new bone thrown massively and irregularly 
around the fragments; but for several months longer, this new 
bone is capable of being re-absorbed, so as to allow the limb 
to become deformed by use, if the patient be attacked with 
severe erysipelas of the limb, or a typhus or other low fever, 
or if he indulge in a series of complete drunken fits. This fact 
is mentioned to shield the reputation of surgeons whose pa- 
tients have found their limbs crooked some weeks after the 
attendant has pronounced them well; and also, to caution drunk- 
ards; to induce patients attacked with erysipelas within six 
weeks after recovering from a fracture of a lower extremity, 
to retire immediately to bed; and to persuade these, and fever 
patients, not to rise on becoming convalescent, without calling 
for an examination of the state of the limb. The perfect and 
final union of a fracture requires from one to two years; and 
when it is accomplished, all the unnecessary parts of the rude 
mass which formed the first bond of union will be found to 
have been removed by the absorbents. 

The description of the progress of union which has just 
been given, is adapted to the history of cases occurring in 
adults. In children, the stages are always much more rapid. 

We shall now proceed to give some very short directions 
for the DM nt of particular fractures occurring on the 

road, at sea, on distant plantations, or in other situations 
where surgical assistance is unattainable for many days. 
These directions are merely temporary, and are designed to 
procure the patient as much freedom from pain, and security 
from deformity, as can be obtained fey simple contrivances 
every where at hand, and applied by persons without surgi- 
cal knowledge. 

These plans, though many of them are vastly inferior to 
those employed by surgeons, are yet sufficient to prevent 
much evil; and, in many cases, they may even effect very to- 
lerable cures. 

Fracture of the Clavkle. — A fracture of the clavicle or 
collar bone, permits the shoulder to approach the side. As this 
change will relax the muscles which support the shoulder, it 

11 



322 FRACTURES OF THE CLAVICLE. 

is allowed to fall an inch or two, and as the base of the 
shoulder blade cannot retreat far, the arm is rolled forward 
upon the breast. The indications of cure arc, to keep the 
shoulder far enough from the side, and on a level with its 
fellow. To effect this, take a block of the lightest dry white 
pine or cedar, and trim it into a wedge, four inches broad, one 
and a half thick at its upper part, tapering nearly to an 
edge below, and long enough to reach from the arm-pit to 
within two inches of the prominence of the elbow joint. 
This block should have all its edges and corners smoothly 
rounded, and should then be thickly wrapped up in linen or 
muslin, the whole being suspended on two very broad tapes, 
or pieces of bandage, secured near the middle of the narrow 
sides of the wedge. Now make a kind of stall or short - 
for the elbow, of brown hollands, or other firm tissue. Let 
this rise about three inches behind the elbow, and run about 
four inches along the fore arm, when bent at right angles with 
the arm. Two wide bandages, each about lhre<? quarters of a 
yard long, are to be firmly sewed ; one to the back part of 
the sling on the side next the body, a little above the point of 
the sling which receives the elbow; the other, in front, to the 
edge of the sling which corresponds with the outer side of the 
elbow joint. To apply the apparatus, proceed as fol! 
Seat the patient on a stool, or chair, without a back. Let an 
intelligent assistant raise the arm of the injured side directly 
outwards from the body, till it is nearly horizontal; and, p! 
one hand under the arm, a few inches below the axil! 
him raise the shoulder considerably above its usual level, 
when standing at ease. The operator now places the thick 
end of the covered wedge as high as possible in the arm-pit, 
with its slope running perpendicularly down the side. 

The tapes which support the wedge are then carried up. 
the one before, and the other behind the chest, to the sound 
shoulder, where they arc carefully tied over a strong com 
of linen or muslin, which protects the skin from creases. The 
arm is now brought down to the ride, over the middle of the 
wedge, which presses the shoulder outward. The sling being 
now fitted on to the elbow, and a little cotton, fine tow, or Max 
being interposed, the bandages are secured tightly over the 
opposite shoulder, in the same manner as those of the w 
This supports the shoulder it the required height To render 
all secure, fold a soft long towel, in the direction of its breadth, 
till it is six or eight inches wide; pass it firmly and cv 
round the chest, over the lower part of the arm. aod all the 
dressings; stitch or pin it tight in front, and secure its upper 
edge to the edges of the wedge cover, and to each of the sling- 
hands. The hand may be supported in a common handker- 



FRACTURES OF THE SHOULDER AND ARM. 323 

chief sling, but should not be brought close round in front of 
the chest, or the circulation in the arm will be arrested. 

This rude treatment will not prevent all such deformity as 
might be important to the appearance of a young girl; but it 
will secure a safe, strong, and not unsightly cure in a man 
who is not particularly fastidious about good looks, or when 
placed beyond the reach of surgical aid. 

Fractures of the shoulder blade. These are rare, but 
sometimes occur in heavy falls and in partial inhumation un- 
der fallen banks. The unprofessional practitioner can do very 
little for their relief. Their existence may be known cither 
by the irregularity of the fragments of the bone as the finger 
traces their outlines beneath the skin, or by a grating of the 
fragment upon each other, when different parts of the bone 
are pressed upon by the palm of the hand. \i surgical aid 
cannot be obtained, it is proper to bind the arm lightly to the 
side, and leave the case to nature. In some cases the patient 
will recover without loss of power or appearance; in others, 
there will remain considerable deformity, and serious limita- 
tion of some of the motions of the arm. 

Fractures about the shoulder joint. Accidents of this 
character are numerous, often very obscure, and require the 
highest surgical skill for their treatment. When, unfortu- 
nately, it is impossible to obtain such aid, we can do no other 
than secure the arm at rest in the easiest position; but the use 
of the limb, to a \c\y serious extent, will generally be lost. 

Fractures Qf the arm. These are known by an angularity 
or unnatural flexibility of the bone, somewhere between the 
elbow and shoulder, and by the grating of the fragments when 
the arm is moved. In the absence of a surgeon, much good 
may be done by the following plan, when pursued by an intel- 
ligent person accustomed to bandaging. Make a flat com- 
press of linen or muslin simply folded, three inches wide, half 
an inch thick, and long enough to reach from the arm-pit to 
near the point of the elbow ; — secure this to the side by two 
short bandages, stitched to its edges and tied over the opposite 
shoulder, and steady it by a turn or two of abroad bandage round 
the chest and compress, allowing the latter to incline a very lit- 
tle forward as it descends. Then, with a penknife, prepare three 
narrow strips of thin, well planed cedar shingle, each from an 
inch to an inch and a half wide. Make one of them long 
enough to pass from the back of the shoulder joint to the tip 
of the elbow, along the back of the arm; one, to extend from 
the outside or point of the shoulder to within an inch of the 
external prominence of the elbow; and the third, from the 
front of the ball of the shoulder to just above the bend of the 
elbow. Let each of these pieces be well lined with tow, on 



324 FRACTURES OP THE ELBOW JOINT- 

the side next the arm, and enveloped in muslin. Now let the 
operator take a muslin or red flannel bandage, of about two and 
a half fingers' breadth, and eight or ten yards long, and begin- 
ning at the base of the fingers, envelop the whole limb even- 
ly and smoothly to the elbow. Then, — giving the hand to an 
assistant, with directions to hold the forearm at right angles 
to the arm, while he presses the elbow strongly and steadily 
downward, so as to stretch the broken bone to its full length, — 
the operator, still holding the remains of the roller, sees th.it 
the bone of the arm is rendered straight. He next continues 
the bandage evenly up to the shoulder; and, applying the three 
covered splints in their proper position, he places them in 
charge of another assistant, while he brings the bandage down 
again, so as to surround splints, arm, and all, to near the elbow. 
The arm is now brought to the side, lying smoothly along the 
compress, and the whole is secured to the chest by several 
turns of broad bandage passed round the body and limb. The 
forearm is supported in a common sling. 

Of course, no person alt. unaccustomed to appl 

rollers, and making what are called reverted turns, ran under- 
take this treatment; hut a f. -w leSBOfU D 

useful degree of knowledge of this art. and all who are at the 
head of establishments ought to acquire it. though vn 
sorry to confess that medical graduates of uni\ i loaot 

very generally obtain it. till they In for some 

years as surgeons. Sea captains acquis* it by Looki 
hospitals; and we hav decent cures of frac- 

tured arms performed by such novices at sea. 

Fractures of the pit — None of these <an he success- 

fully treated by a domestic practitioner; hut \n I. 
cannot be obtained lor several days, the use of the limb may 
be lost or preserved by the choice of an attitude; and a 
on this subject is necessary. When the tip of tl. . (the 

piece which projects behind the joint.) is broken olf, it is 1: 
diatcly drawn up behind the arm, where it I ird lump 

some little distance above the joint: while the finger will sink 
into the cavity o( the joint behind, in a manner wholly unnatu- 
ral. It is absolutely necessary that, in this case, the elbow should 
be kept constantly and fully extended even before th- 
is obtained. Let a long piece oi thin white pine or cedar, two 
inches and a half in width, and well rounded at the 
so cut as to extend from near the shoulder to the wrisfl : line it 
well with low, bound on with a bandage or piece of muslin, and 
padded thickly at the middle and the extreme lower end. to 
till the inequalities of the limb. Bind this gently along the 
whole length o( the front of the aim and forearm, 
vender the elbow immoveable; and so let it continue till the 



FRACTURES OF THE FOREARM. 325 

In all fractures of the elbow joint in which the tip retains 
its integrity, the arm should be carried quietly in a sling until 
assistance can be obtained. If left, by necessity, to nature, 
these cases almost always result in the loss of much of the 
motion of the joint. 

Fractures of the forearm. — Whether one or both the bones 
of the forearm be broken, the treatment may be the same. 
The accident is known by an unusual deformity somewhere 
between the elbow and wrist; (which deformity is slight 
when but one bone is broken high up in the fleshy part of the 
limb;) by the inability of the patient to turn the hand; and by 
the pain and grating occasioned when the examiner attempts 
to turn it for him. 

To treat a fracture of the forearm, take two splints cut 
from a planed cedar shingle; one of them, long enough to reach 
from the bend of the elbow, when the arm is flexed at right 
angles, to the t i j > of the middle finger and a little beyond it; 
the otii. i. extending along the back of the forearm, from the 
elbow joint to the wrist joint. Let the part of the long splint 
which covers the palm of the hand, be as wide as the palm 
exclusive of the thumb. Trim oil' the sides of the splint a lit- 
tle at the wrist, SO as to render it not a great deal wider than 
the small pari oftbe arm. From the u rist towards the elbow, it 
should gradually in< little in width, and should correspond 

exa< tlv in form with the short splint These splints are to be 
covered with tow on the side next the limb; and from near" the 
wrist to near the elbow, the tow is to be thickly padded along 
the middle of the splint, but more slightly toward the I 
The tow is to be securely bound to the splints by bandages. A 
roller of two and a hall fingers 1 breadth, and five yards long, 
being provided, every thing is ready. The operator requests 

an assistant to stand behind the patient's arm, and clasp his 
hand in front of the limb, just above the elbow. He then 
grasps the hand; and. while the assistant gives the necessary 
resistance, ho Btretches the forearm, while at right angles with 
the arm, and places it in a position as natural as possible, 
with the palm of the hand looking upward and a little inward. 
lie then applies the long splint, and bandages the hand flat 
upon the broad part, but leaves the thumb free. Having 
reached the wrist with the bandage, he applies the short 
splint also; and, continuing the roller over both splints to the 
elbow, ho secures the bandage, and orders the forearm to be 
carried in a common sling. Prom five to six weeks is about 
the time required for the use of splints, in fractures of the 
upper extremities. 

Fractures of the loxcer extremities. — The precautions in un- 
dressing and iifting the patient, laid down in the sub-section on 



320 FRACTURE5 OP THE THIGH. 

contusions of the perineum and fractures of the pelvis, (p. 220) 
are in great degree necessary in cases of fracture of the 
thigh. There is no difficulty, it is true, in getting off the 
upper garments; but the boots or shoes, the stockings, and 
one limb of the pantaloons must be sacrificed at once, rather 
than that much pain or rough motion of the fractured limb 
should be produced. A hand-barrow, or a plain broad board 
carried on cross-sticks, by four or six men, is a much better 
mode of conveyance for such accidents, than the settee so 
commonly employed. As in injuries of the pelvis, so in those 
of the inferior extremities, the undressing of the hould 

be completed before he is placed on hi> bed. In all fractures 
requiring to be treated in the recumbent position, a matl 
is preferable to a feather bed. During the lifting of t 
tieot into the barrow, or into the bed, one individual should 
retain exclusive charge of the injured limb. 

Fractures of tki thigh. — It is -not to b 
tic practitioner will he able to « ure of fi thigh, 

without considerable deformity - will 

occur, where no o; i. it is w 

state a rude method by which the useitiln< i 
least, ma] ired. Let a malti and let it 

be placed on a strong bi with a light 

wooden floor. Place the Ii upon 

on this. .1 roller towel, and. i: 

large pieces of buckskin. Place th e of but k 

carefully over the perineum, and between the scrotum 
thigh upon the injured side. Place the middle of the t. 
smoothly folded until about three inches broad, dii 
tween the folds of the buckskin on the perineum; an 
one end of the towed behind th .bile 

the other is brought up iu front of the pelvb 
near the arm-pit on the injured side. Now take a stout j 
of window cord or clothes line, and securing one end to the 
two loops o( the towel near the- -trm-j.'. Other be- 

hind the shoulder and up to the head o[ the bed. where it must 
be very firmly secured to the head r the upper cross 

piece of the bedstead, in Buch a manner i 
the surface of the bed. This fixes the .rt of th 

tient's thigh. 

Next, let a stout block of inch white or yellow pine bo nailed 
to the bottom cross-piece oi the bedstead, opposite t! 
the injured limb, and let it be lo 

two below the cross-piece, and so far ;wo\ ■ be level 

with the middle of the hollow of ih« 
the mattress. The upper end of this block 
like a swallow's tail. 



FRACTURES OF THE LEO. 327 

The operator now folds a silk pocket handkerchief, diago- 
nally, until it is about two and a half inches wide in the mid- 
dle. The centre of this, should be applied to the back of the 
ankle, the two tails brought forward and crossed on the top of 
the instep, and then carried downward on each side ot the foot 
to about five inches below (he sole, where they are tied firmly 
in a hard knot. The unexpended ends of the handkerchief 
are then secured to a piece of stout cord, one or two feet long. 
The operator is now ready for setting the limb, which he does 
by grasping the ankle with both hands, and stretching the 
limb firmly, slowly, and regularly, until it appei . iy, or 

quite of the full length. An assistant j rd at- 

tached to the handkerchief over the notch in the foot- block, 
and, by tightening it from time to time, i ecu res all that the 
opera s. When the extension h d a- far 

as desirable, the cord is tied round the projecting bottom of 
the block, and the operator proceeds to support the foot by 
pillows at the sides, or some other contrivance to prevent the 
from turning tin- broken limb outward bv their weight 
To prevent the bed-clothes from touching the limb, lie takes 
three keg-hoops, cuts them in half, and, making a double se- 
micircular arch of each, by tying the corresponding halves 
together, crosswise, he pla< - athwart the 

limb, beneath tin.' clothing. The limb should be measured 
frequently from the front point ot' the share- bone to the point 
outer ankle : and whenever the limb is found I 

k tension bhould be I, and the cord lightened. It 

i< best to place the second piece of buckskin between the 
handkerchief and the loot, to prevent ulceration, which it 
to occur during extension, which must continue live- w< eks. 

— Little can he done towards setting a 
fractured leg, bv any but the best surgical anatomists, when 
is much displacement among the fragments; but, for- 
tunately, iu a great number ol there is very little dis- 
| uent. 'J 'he treatment is then very simple, and the domes- 
tic practitioner may imitate the surgeon very cl< - 

Take a planed inch board, loni: enough to reach from six: 
inches above the knee to three inches below the heel. Make 
it ten inches wide at the top. and seven at the bottom. On the 
bottom, nail a foot-piece, standing Up at right angles, or inclined 
a very little downward by a bevel. Let this foot-piece be five 
inches wide, bv ten inches high, with a semicircular top. Now 
make two lateral splints, as long as the back-board already 

ibed, and let them be six inches wide at the bottom, eight 
inches wule at the top, and one inch thick. Along one mar- 
gin of each of these lateral splints, and along both margins of 



328 FRACTURES OF THE FINGERS AND TOES. 

the bottom board, bore four spike gimlet holes, at equal dis- 
tances. With eight pieces of stout tape, tie the lateral splints 
to the bottom board, so as to allow them to move as on hi: 
(which latter are, of course, preferable, when obtainable,) and 
we have a very decent fracture box for broken legs. To em- 
ploy the apparatus, lay a soft, thin feather pillow on the box, 
with the lateral splints expanded, and over this, if you have 
one, a cloth of oiled silk or India rubber. Then, the limb 
having been previously extended, the foot brought into a 
natural position, and all great irregularity in the line of the 
shin bone removed, the operator carefully lifts the limb with his 
two hands, while an assistant { fi ;u lure-box and pil- 

low beneath it. The leg being laid carefully on the pillow, 
after it has been a little hollowed out at 1 and calf, the 

lateral splints are turned up, and three or four broad t 
doubled, being passed under the whole fracture box, arc tied 
at one side, so as to produce moderate pressure on the leg. 
The limb is then covered with bran thrown down on th 
low, and the dressing i 

without other dressings, when the limb i- slightly < 
or has received small wounda at the time of the accident It 
usually crusts with the blood and fluids over rock Inch 

get well rapidly beneath ; but, if suppuration 
off most kindly with Castile soap and warm water, and - 

newed in a moment. Bran is even the 

the strips and salves used in large wounds; and r the 

poultices, in bad compound fractures. It absorl - 

fluids, preserves cleanliness, and excludes the fly. We have 

seen it applied directly, with the happk 

face of the worst lacerated wounds. 

Fractures of the Finger* and Toes, — When tin-- parti arc 
crushed by weights, poultices as well . rally 

necessary; but, whether in simple or complicated lVaetm 
the hand, it i< best to bifid the whole hand to a splii I 
to the form of the edges of the palm and lin_ 
thumb, and extended as high ;b the museu! 
arm. to check the motion of the wrist When the thumb is 
broken, we use a little splint, which I e ball of the 

thumb, and. becoming rapidly narrower as it appro 
first joint, extends to the end oi the last joint 
flexion. It is bound on by a very narrow strip of ban 
which, after enveloping the thumb, makes two or three turns 
round the wrist, and is finally secured hv a pin over the ball 
of the thumb. 

The toes are very rarely subject to simple fractures. When 
such accidents occur, we treat them by m ' splint to 



FRACTURES OF THE LOWER JAW. 329 

the sole of the foot, with suitable compresses and bandage, pro- 
hibiting the foot from being put to the ground for at least four 
weeks. 

Fractures of the lower Jaw. — The uninitiated can do nothing 
with these troublesome accidents, except to support the chin 
by a handkerchief tied over the head, securing it by another 
passed round the temples, and feeding the patient entirely 
on broths and gruels till a surgeon can be obtained. 

Before quitting entirely the subject of fractures, a few ge- 
neral remarks must be made. The diet of a patient with frac- 
ture, for the first week, should be low; but there can be no 
greater mistake than the continuance <if low diet for a longer 
!>eriod, without argent necessity. The labour of uniting a 
broken bone, when once commenced, i- one : and na- 

ture require* the support of a generous diet, from the end of 
the first to that of the sixth week. A pretty free use of good 
porter or ale, daring this period, is not at all amiss, when there 
exist no constitutional objections to it. A neiilect of this rule 
we believe to be the most common cause of imperfect unions 
and false joint i illy in the public alms-houses of the 

country, and in those of some cities, where public charity is 
| < I on an exceed ing ly economical 

An adult patient, who has had a fracture of the inferior ex- 
tremities, may relinquish his splints in live or six weeks, and 
may be subjected to frictions and passive motions of the limb 
to remove stillness; but he should not be permitted to rise, with- 
out the permission of a surgeon, till the completion of eight 
weeks. A boy of twel\ ma? throw off Ins >[>lints a week 

earlier, and may rise in six w< < kft 

An adult who has had a fracture of a Superior extremity, 
may throw the apparatus aside in live weeks, and a boy of 
twelve years in four. The former may apply the limb to light 
in six, and the latter in five weeks. 

The bug Confinement on the back, in fractures of the lower 
extremities, render it accessary to guard against ulcerations of 
the back and buttocks from constant pressure, in weakly peo- 
ple. By changing the point of support with down or air pil- 
lows, this terrible evil, when threatened, may be prevented. 
Bvefl when surgeons are in attendance, it is safest for the 
friends to look after this matter occasionally, especially in fe- 
males. The use of the bed-pan, an absolute necessity when 
common beds are used, is often extremely annoying and pain- 
ful. Beds which remove this difficulty by very simple ma- 
chinery, have been invented by Drs. B. II. Coates, and Caspar 
Wistar. They are in use in hospitals, and the wealthy at a 
distance may be put in the wav of obtaining them to order by 

12 



330 OF DISLOCA'li' 

addressing Mr. Samuel Sheppard, druggist, South Ninth Street, 
Philadelphia. I believe that they are no where kept on sale. 

Of Dislocations in general. When the extremity of a bone is 
thrown out of the eavity which is intended to contain it, it is 
said to be dislocated, or put out. This accident, when sudden, 
is always attended with a laceration of some of the ligaments, 
and a severe stretching of others. Portions of the edges of 
the bony cavity of the joint are often torn oirby the ligaments. 
Some of the muscles attached to the dislocated bone are re- 
laxed, and others are violently elongated. If the bone remain 
out of place for any length of time, the relaxed muscles con- 
tract and hold it almost immoveably in its new position. The 
torn ligaments soon unite with surrounding parts, so that in old 
dislocations they must be re-torn before the bone can be re- 
placed. After some weeks or monl f the old 
joint begins to be tilled up with bone and cartilage, whi 
edges are absorbed and rounded oil*. In ' time, the 
distorted muscles become slowl to their new po- 
sitions; their functions are partly . ! nature com- 
mences the formation of a rude new joint, by throwing out an 
irregular cup of new bene round tl 

changes Bhow the ne< tude in reducing dislo- 

cations as speedily as possible; K. lour of dcla 

pidly increases the resistance: 
of those pretenders, called bon 

dislocations of several years' standing; or, in other v 
undertake to restore the bone to a eavity w i long 

ceased to exist ! But the gullibility of the public is without 
end; and the only reward of the professional man who 
tures to denounce the ignorance of ; -host 

blunders swell his recei he pitiful chai pur- 

pose and selfishness! The deaths and miseries occasioned by 
these pretenders are buried in oblivion, while the few appa- 
rently brilliant sue _ eons have 
failed" are bruited about with all manner of • K I 
it must be confessed there is reason to fear that the opportu- 
nity for some of t: i furnished by the culpable 
habit of certain excellent medical practitioners, whose want of 
advantages and exclusive pursuits have rendered them 
rant of the first principles oi ibit of taking 
charge of surgical cases: — which are thus removed from the 
notice of those whose professional studies tit them for such un- 
dertakings. It is time that the pul . that to 
profound medical scholar or teacher and a m 
practitioner, though it by no means .ends in no cl. 
to prove a capacity for treating the most simple dislocatk : 
other surgical cas 



DISLOCATIONS OP THE ARM OR SHOULDER. 331 

There are, we believe, but three kinds of dislocation in 
which the domestic practitioner can make himself useful. Of 
these we will speak. 

Dislocation of the arm into the armpit. When, after a fall, 
or blow on the shoulder, the arm is found fixed at an angle of 
thirty or forty degrees with the side of the body ; when the 
patient has lost nearly all command of its motions, but when 
an assistant can move the elbow backward or forward a few 
inches, with great pain to the patient: when the elbow can 
he lifted directly outward from the body, without much pain, 
till the arm is nearly horizontal, but cannot possibly be made 
to approach the side, the mere attempt producing intense suf- 
y\ when the point of the shoulder stands out sharp and 
clearly marked, and the round muscular prominence immedi- 
ately below it is flattened, so that the linger, when pressed 
inward immediately below the point of the shoulder, seems to 
sink into a kind of cavity; and when we can feel, in the arm- 
pit, a large, round, bonv lump, which has no business there; 
we know that the arm is dislocated downward into the arm- 
pit. 

If, in such a case, a surgeon cannot be procured within two 
hours, an intelligent assistant can, and ought, to attempt the 
reduction without delay; and, by following these directions, 
he may almost a! ceed with very slight effort. 

Let the patient lie flat upon his back on the floor, with his 
head supported by a pillow. The operator then seats himself 
also on the floor, clo>e by the side of the hip of the patient, 
on the injured side. Extending the h j he patient he 

then places the sharp outside vx\^ of his foot between the side 
of the body and the bony lump formed by the head of the 
bone in the arm-pit. The sole of the foot looks outward, and 
forms an inclined plane for the head of the bone to slide over, 
while the instep presses the patient's side. The operator now 
grasps the wrist of the injured arm, and, drawing it obliquely 
downward, while carried as far outward from the side as the 
natural position of the limb after the accident shows to be 
necessary, he applies a long, regular, gradually increasing 
force, until he feels the limb begin to elongate a little. As 
soon as this is perceived, and while the extending force is 
fully maintained, he makes a gentle attempt to carry the arm 
toward the side. If successful, the head of the bone will sud- 
denly fly into its place with a snap; if he fail, the extension 
must be continued and increased; and, after a time, the at- 
tempt to bring the arm to the side must be repeated. Suc- 
cess generally follows in five or ten minutes. The force re- 
quired is often exceedingly slight; but it is sometimes very 
considerable, and it is, therefore, best that the operator should 



332 DISLOCATIONS OF THE WRIST AXD ANKLE. 

be a rather powerful man, and capable of continuing a consi- 
derable amount of extending force for many minutes together. 
There are several other forms of dislocation of the arm; but 
none of them are manageable except by surgeons. They are 
rare; and we have no wish to induce rashness to meddle with 
such cases, by communicating a partial knowledge of the sub- 
ject. ' 

Dislocations of the Wrist. — These accidents occur in va- 
rious directions, and may be either complete or partial. Their 
nature is too obvious, when they occur, to admit of any doubt 
even on the minds of those who know nothing of surgery; and 
when the best aid is not obtainable within an hour or two. it 
is right to attempt the reduction, which is rendered vastly more 
difficult after swelling and inflammation have supervened. 

One law will apply to the mode of reduction, in all the va- 
rieties. Let the surgeon grasp the forearm, above the wrist, 
firmly, with one hand, while with the other he seizes tlv 
located hand. Let him then make gradually increasing and 
very steady extension, in the direction in which the fi 
point in each particular case, and when the hand evioN 
begins to yield to the extension, gradually, and without force, 
it may be brought into its proper position. 

Dislocation of the tflnkle, with Fracture of the Fibu! 
This common accident sometimes happens from turnii i 
the side of the foot, and somei lows, or ] 

sure on the outside of the leg. It may be known by a want 
of firmness in the bone immediately above the external ankle, 
which feels as if beaten in, and by the undue ease with which 
the sole of the foot can be made to look outward to an impro- 
per extent. The best treatment for this accident, when a sur- 
geon cannot be procured, is that prescribed for fractured leg, 
with but slight modifications. There is no difficulty, whate- 
ver, in replacing the foot; but the muscles have a constant 
tendency, though not a forcible one. to tilt it outward again. 
To check this; place the limb on the pillow, in the common 
fracture box described under the head of fractures of Um 
use the feathers in the pillow, or the bran, or a folded towel 
between the pillow and box, to make a kind of compress 
which shall press the outer edge of the foot inward, and turn 
the sole of the foot in the same direction, slightly. The part 
of the pillow pressing on the inner ankle should be, alse. 
ported by a compress placed between it and the box. while 
the part opposite the outside of the limb, for three inches 
above the external ankle, should have the feathers shaken 
from it, so as to press as lightly as possible. This attitude 
being preserved until the fracture unites, will secure the ankle 



EXTERNAL INFLAMMATION. 333 

joint against serious loss of power, though it will probably re- 
main a little weakened. 

Wlienevera limb has been dislocated and reduced, it should 
be confined in a motionless position for two or three weeks, 
in order that the torn ligaments may re-unite; and if this be 
neglected, the displacement is extremely apt to recur. 

We have now given all the advice we dare venture to give 
the uninitiated, in relation to dislocations. In all cases except 
those above mentioned it will be safest to let the case rest for 
surgical advice, however tardy, rather than to increase the 
danger to life or limb by awkward efforts. A perfectly sim- 
ple and manageable dislocation may, by a little ignorant tam- 
pering, be rendered almost, or quite irreducible, to the infinite 
torture of the patient. 



section v. 
On Inflammation and its Consequences. 

It is so utterly impossible to lay down any course of treat- 
ment in inflammations and their consequences which will not 
be liable to exceptions too numerous to be specified, that it 
becomes most important that even the domestic practitioner 
should take a broad view of the subject, and possess himself 
of certain general principles, before he ventures to study the 
special directions given in this section. His general know- 
ledge and practical good sense must often be permitted to 
modify even his application of those directions. I must, 
therefore, beg the reader who has read the preceding chap- 
ters of this work to recur, with serious attention, to the sec- 
tions on the Reproduction of Parts, (p. 133,) Symptomatic 
Fever, (p. 13S,) Irritation, or Hypernutrition, (p. 147.) and In- 
flammation, (p. 153,) in the Physiological chapter. This he 
should do before he commences the study of the present 
section. 

External Inflammations, (in which, alone, with their 
consequences, the surgeon is interested,) whenever they are 
somewhat considerable or severe, yet not sufficiently violent 
to produce collapse of the system, present us with at least three 
deviations from the ordinary actions of health. The inflamed 
part itself, — in a state of actual disease, with its vessels weak- 
ened, and rendered incapable of resisting the force of the cir- 
culation, — contains more blood, and circulates, at first, a larger 
amount of this fluid than natural. The nerves of the part are 



334 TERMINATIONS OF IXFLAMMATIOX. 

rendered painfully susceptible of all impressions by this in- 
creased supply, and even the distention of the part becomes 
a source of pain. The activity of some of the functions of the 
vessels is even increased by their development, and the ani- 
mal heat is, for a time, elevated even above the height neces- 
sary for the most rapid reproduction of parts. The heat, red- 
ness, swelling, and pain are, therefore, carried beyond the 
standard of health. Nature takes the alarm lest this excc^ 
condition should unfit the part for the exercise of its func- 
tions; and she immediately prepares for its destruction and 
replacement, should the severity of the injury render this neces- 
sary. The centre of inflammation is every where surrounded 
by blood vessels in the highest state of activ itinating 

the cellular tissue with lymph, and drawing a line of circum- 
vallation around the disease, which, even should it prove un- 
necessary, is still a sanative attempt To support this activity, 
and to prepare for all chat rteries leading to 

the part become gradually dilated, and the heart 
make additional efforts to increase the supply of blood ; or, 
in other words, symptomatic fevt r is indue 

It is very probable that, when the human 
and the vigour of I I by luxe 

vice, this process usually terminated without Q the 

best cure of which the nature o\ the case admitted, A: 
savage tribes, — none of which, however, can !»<■ consklen 
approximating very nearly in pi nditioo t" the race 

in its primitive state, — the history ot inilammai tions 

seems to lend some colour to this hv 

But, in these degenerate day*, man has become artificially 
modified to such an extent that the "vis ir.edicatrix nat 
itself must be ridden with curb and lash, or it will ii 
overleap all reasonable bounds. 

Before speaking of the treatment, let us take a view of the 
several terminations of inflammation, as the] died. 

These are in reality but ti . and 

mortification; but nearly all >■. Ihere to the folio 

list; vie. Resolution, effut pur a t ie n , ulceration, and 

ga?i^rejie or mortification* 

When all the symptoms of inflammation gradually decline 
and disappear, naturally or under the action of remedies 
no signs in the part of the pre-, 
to terminate by resolution. 

When, from longer continuance, the distension so far e: 
bles the vessels that they become unable enli \pel their 

undue contents by the natural route, they frequently transmit a 
portion of the more fluid parts through their coats into tin 



TREATMENT OF INFLAMMATION. 335 

rounding cellular tissue, in the form of clear or bloody serum ; 
and the inflammation is then said to terminate by effusion. 

The title of termination by effusion is also given to that 
process by which blood vessels, irritated to a high degree of 
activity, secrete lymph or other matters in the interstices of the 
capillaries, so as to form a tumour or callosity more or less per- 
manent; but this result is directly connected with hyper or 
morbid nutrition, or with the reproductive power of nature, 
and is not, strictly speaking, a consequence of inflammation : 
it is very frequently witnessed in enlarged glands. Termina- 
tion by effusion, then, is but a modification of that by resolu- 
tion; for the effused fluid, if the disease terminate at all, soon 
disappears by absorption, leaving no trace behind. 

When the injury done to the vessels in the centre of the in- 
flammation is so great that they are gradually unfitted for ful- 
filling their part in the system, and are irrecoverably altered, 
begin to undergo a process of absorption to make way 
for the formation of new pan-. A cavity is thus formed, which 
is always lined with a new membrane, and the new blood ves- 
f this membrane secrete pus or matter, which continually 
dilates the sac, filling up the space I the inflamed and 

M parts are absorbed. Thus is formed an abscess; and as 
cretion of the pus rapidly relieves the inflammation where 
it is mildest, it gradually subsides and is said to terminate by 
suppuration. 

Inflammations of mucoid metimes those of 

vin when diverted of its cuticle, terminate by suppuration 
without loss of substa: 

When the same condition of parts that has just been noticed, 
occurs immediately upon the surface, or when l iperfi- 

cial ibseesfl bursts < Eternally before the inflammation subsides, 
ire have an open sore instead of a cavity, and the inflamma- 
tion is said to terminate by ulceration: but as such ulceration 
is uniformly attended with the secretion of pus, this obviously 
constitutes a mere variety of the termination by suppuration. 

When the violence of the inflammation is so great as to de- 
stroy suddenly the vitality of the part, before absorption can 
begin to remove it, it is said to terminate by gangrene or mor- 
tification. 

Treatment. The great object in the treatment of inflam- 
mation is, if possible, to bring about a resolution; and the 
means are various. 

1st. All external and mechanical sources of local irrita- 
tion should be removed. When the inflammation affects the 
skin, the atmospheric air itself becomes a source of irritation, 
by increasing the vitality of the blood; and hence, we often 
guard the part by covering it with flour, or cerate; as, in ery- 



336 TREATMENT OF INFLAMMATION. 

sipelas; or with mucillage; as, in inflammation of the eye. Mo- 
tion is a powerful mechanical irritant; hence all inflamed parts 
should be kept strictly at rest. Often, the pressure of the skin 
or a fascia' acts mechanically to produce intense irritation in 
the inflamed parts beneath; hence we divide these bands freely 
by the knife; as, in laying open a whitlow, or the capsule of a 
swelled gland. 

Sometimes the inflammation attacks delicate soft parts inter- 
laced with rigid tendinous fibres, and we are obliged to divide 
the swelling in various directions, or even to destroy it totally 
with vegetable caustic; as we often do in carbuncle. 

2nd. Means should be used to cause the vessels to con- 
tract, and drive the blood from lite part: but the ?7iean$ 
should be sedative. Cold, and certain astringents are the re- 
medies chiefly employed for this purpose. Cold water, ice 
water, water cooled by dissolving in it the muriate of ammo- 
nia, and lead water, which is a cold solution of the acetate of 
lead, are generally employed, and one or the other is a desi- 
rable application in almost every commencing inflammation of 
moderate extent. To be effective, cold must be applied con- 
stantly till the heat of the part is reduced below the natural 
standard. If the part cannot be immersed in the refrigerating 
fluid, or the latter allowed to fall in a steady stream upon it, 
we must use rags thoroughly wet, and very frequently changed 
till the cflect is produced. 

3rd. Pain, which is a gnat I • may be occa- 

sionally checked to advantage by nan < -. Thus we use 
wet with laudanum, even in anticipation of inflammation, in 
severe contusions of nervous parts; as in a mashed finger. In 
certain extensive inflammations, the watery solution of opium 
is exceedingly useful; as. in wide spread erysipelas of any other 
parts than the head and face. In severe injuries to ligamen- 
tous parts, occurring to feeble or delicate patients, a hop poul- 
tice has a happy eflect on this principle: as, in some sprains 
of the ankle. 

4th. 77k- quantity qfbiood in the attire blood vessels around the 
inflamed part, should be directly and indirectly diminished. 
is done indirectly by cold applications, and directly by the 
employment of leecb 

5th. The force of the heat:' . and the quantity of the ge- 

neral circulating fluid, should lh lessened. ThlJ • 
low diet, purgatives, diuretics, diaphoretics, and all measures 
calculated to increase the secretions in other parts: and, still 
more directly, when the condition of the patient will permit, 
by bleeding from the arm. 

6 th. he may often do ynueh ?ochI by drazcing off the surpiu 
tality of the inflamed part by counter :nd the undue sup- 



TREATMENT OF ABSCESSES. 337 

ply of blood by calling it to distant parts. The first is often ef- 
fected by issues and seatons to the back of the neck, in inflam- 
mations of the eye and ear, and the latter by dry and wet cup- 
ping, and by blisters, in deep-seated inflammations. 

7th. When the general force of circulation is sufficiently reduced, 
either by the debility induced by very extensive inflammations or by 
artificial depletion, ice may give relief by causing effusion directly 
from the neighbourhood of the injlamed vessels. Though this is 
usually effected by powerful stimulants, the relief following 
the subsequent effusion, more than counterbalances the tempo- 
rary increase of the disease from the previous irritation. On 
this principle we use blisters over inflamed glands, and directly 
upon surfaces affected with erysipelas. 

When an inflammation shows a disposition to terminate by 
effusion, the circumstance almost invariably marks a complete 
crisis in the disease; and, with some caution in keeping the 
force of the general circulation down to the natural standard, 
the case may be left pretty much to nature. 

When the effusion is considerable, and does not appear dis- 
posed to yield readily to absorption after the inflammation 
has subsided, it is sometimes advisable to hasten its retreat by 
moderate pressure with a bandage, or by bathing the part with 
brandy, or whisky and water. This condition is frequently 
noticed in the skin after erysipelas. 

When it is ascertained that inflammation will not terminate 
by resolution, but is running on to suppuration, (a condition 
easily known by a throbbing pain in the tumour, by the swell- 
ing beginning to approach the surface at some particular point 
with more rapidity than usual, and ui last, by a discoloration of 
the skin over this point,) a change becomes necessary in the 
plan of treatment. It is still an object to lessen the severity 
of the inflammation, and the activity of the circulation around 
the inflamed part, in order to prevent the undue extension of 
the abscess; but it is also desirable to hasten the suppuration, 
and to bring it as soon as possible to the surface or within 
reach of the lancet. 

To effect this, while we continue for a time the use of low 
diet and gentle purgatives, we apply a warm bread and milk 
poultice, changed twice a day, to the centre of the inflamma- 
tion; and as soon as we can perceive a fluctuation, or the mo- 
tion of a wave of matter when tapping the sides or top of the 
tumour with the tips of the two fore-fingers, we plunge in a 
lancet and evacuate the matter. The local treatment is then 
regulated precisely as that for uniting wounds by the second 
intention. 

When the abscess is very large, and the discharge profuse, or 
when the patient has been greatly debilitated bv other causes* 

I ■" 



338 TREATMENT OF SPREADING ULCERS. 

» there is a great tendency to sink; and the strength must be 

supported by a generous and highly nutritious diet, sometimes 
with the addition of porter or wine, the use of bitter tonics, 
and the mineral acids; such as ten drops of the elixir of vi- 
triol, (aromatic sulphuric acid.) three drops of nitric or mu- 
riatic acid, or five drops of the muriated tincture of iron, to 
be taken twice or thrice a day, in half a tumblerful, or more, 
of water. Soaking the feet every night in the nitro-muriatic 
bath, (see Index,) is often extremely serviceable. This sin- 
gular remedy frequently produces a salivation, but without 
shock to the constitution, or that danger of taking cold which 
attends mercurial ptyalism. 

When inflammation terminates, or endeavours to termi- 
nate in ulceration, the ulcer may be found in either of four 
conditions, dependent on the state of the surrounding parts: — 
and here we exclude the varicose ulcer, which has been treat- 
ed of elsewhere. — In one condition, the inflammation subsides 
entirely as soon as the ulcer has reached its greatest dimen- 
sions under the action of the bread and milk poultice, which 
is used here, as in the abscess, to promote the rapidity of the 
necessary changes. The ease is then analagous to a simple 
wound with loss of substance, and will recover under similar 
treatment This is what most sin "g ve termed healthy 

ulcer. It is formed by disease, and is then not healthy: it be- 
comes healthy when the inflammation ceases, and is then, pro- 
perly speaking, no longer an ulcer. 

In another condition, not distinguished by any particular 
name among BUI the inflammation, instead ol 

ceeding in effecting a termination when the ulcer ij 
seems to propagate Itself all around, from the ulcer as a cen- 
tre; the latter enlarging continually, as the inflammation de- 
stroys the fitness of the neighbouring parts to fulfil their func- 
tions. The burrowing and phagedenic utcers of sui 'g 
belong to this i metimcs the inflammation travels 

superficially, and the parts beneath the destructive operation 
retaining their healthy powers, the ulcer may heal from the 
centre, even while it enlarges round the circumference : as 
we see in Rtipia and other aflections of t 1 -:>mc of a 

scrofulous, and others of a syphilitic character. This condi- 
tion marks the absence, or the imperfection of the proc> 
.which the reproductive power ol' the system end 
arrest the progress o( inflammation: and it clearly ind 
a bad state of the general health. It is found that. • 
tensive and rapid, these ulcerations require, for their cm 
solute rest of the whole person, moderate, but not too i 
diet, and regular purgation; a fe^ of calomel 

occasionally added to the saline or other cathartics empl 



TREATMENT OF IRRITABLE ULCERS. 339 

The mineral acids, as prescribed in excessive suppurations, 
are also highly serviceable. Locally, the application of cold 
seems to be interdicted, and the simple bread and milk poul- 
tice proves inefficient. I have found a poultice composed 
one half of the crumb of bread, and the other of coarsely 
broken leaves of cicuta, (co?iiu??i macalutum,) prepared with 
milk in the usual way, the most powerful of all local measures 
in the treatment of the burrowing and phagedenic ulcers. 
Notwithstanding the rapid advance of the habit of treating 
syphilis without mercury, I still invariably endeavour to pro- 
duce and maintain a slight copper taste in the mouth, by 
means of pills of one grain of calomel, in every case of rapid 
and deep ulceration, apparently of syphilitic origin. Cases 
that resist every thing till this impression is produced, will 
often get well immediately after, under the use of cicuta. In 
rupia and some other similar exulcerations of the skin, the 
pure extract of cicuta, made into an ointment with a very 
little lard, will often effect great relief; but proper rupia is a 
most unmanageable affection. Calomel given to touch the 
mouth is inadmissible in these cutaneous cases; but calomel in 
the form of an ointment, applied directly to the sore, is often 
useful. We might dilate upon the thousand remedies which 
occasionally cure slight, and ill-defined ulcerations of the 
skin; but the extreme difficulty of distinguishing the very nu- 
merous varieties of these atfections, must for ever keep them 
within the province of a select circle of professional men, who 
pay particular attention to diseases of the skin. 

In a third condition, the parts around the ulcer arc relieved 
of the activity of inflammation; but the blood vessels, instead 
of returning to a healthy state, seem to undergo some unknown 
change of action which keeps up an excessive excitability of 
the nerves of the part The ulcer is extremely painful; some- 
times constantly, and sometimes periodically; and its edge is 
j liar or jagged. The granulations often form with great 
rapidity, and nearly fill the sore; when suddenly, and without 
apparent cause, they totally disappear, leaving the sore as bad 
as ever. The discharge is seldom of pure pus, but more ge- 
nerally an irritating and thin ichor. These ulcers occur most 
frequently in the neighbourhood of moveable joints, and par- 
ticularly in that of the ankle: they are the irritable ulcers of 
surgical writers. The most absolute rest of the neighbouring 
joints, and of the part affected, must be secured; and, if neces- 
sary, this must be done by splints of carved wood, moulded 
tin, or wet book-binders' board, bound on the limb, and allowed 
to dry there. The ulcer must be dressed with narcotic poul- 
tices, of which the best are those prepared with bread and 
milk mingled with cicuta, (conium macidatum,) Jamestown 



340 TREATMENT OF INDOLENT ULCERS. 

weed, {datura stramonium,) and opium; and, in some cases, 
the poultice of boiled hops and vinegar will prove serviceable. 
The dressings must be light, for the part will not tolerate 
much pressure; and as no one article agrees with it for many 
days together, the poultices may be alternated with ea-ch 
other, and with plasters of simple cerate, or of this ointment 
mixed with about one-eighth of its bulk of sugar of lead. 
Surgeons sometimes relieve the most obstinate of these ulcers, 
by burning off the whole surface with vegetable caustic, ( 
tic potass,) and dressing with the bread and milk poultice, 
until the slough is separated. The new sore thus created 
sometimes resembles a healthy wound, and heals without dif- 
ficulty. 

In the fourth and last condition, the edges of the ulcer are 
thick and rounded; the whole sore is surrounded by a callo- 
sity, which appears to embarrass the restorative powei - 
though the absorbents had failed in removing all the parts which 
are rendered incapable of perform in 5 their proper duties by 
the inflammation, and had saddled them, weak as they are, 
with a task of reproduction, of which they are incapable. 
The discharge is sometimes purulent, sometimes watery, and 
sometimes almost imperceptible. At one time, there will be 
no visible granulations; at another, the sore will be filled with 
such as are large, rounded, pale, anil flabby; instead of small, 
conical, bright red, and firm. In some cases, on the contra- 
ry, the bottom of the ulcer is covered with small, pale granu- 
lations of very slow growth, and almost cartilaginous hardness. 
The cavity is generally deep, and the edges overhangi: _. — 
Such ulcers are most common on the 1 I, and 

arc the indolent ulcers of surgical writers. 

These ulcers require the emplovment of . to pro- 

mote the absorption of the callosities «>r d< bicfa sur- 

round them, and assist in rendering them indok at 
is best applied by means of long and broad 

plaster, drawn tightly across the sore, and supported by a 
well applied bandage and compress. They shook] he chai 

or tightened, once every other day, at farthest; and if an] 
dancy to erysipelas appear on the neighbouring skin, the 
strips must be omitted, and the Iv d compress relied 

upon solely. Poultices, or any other moist applications, con- 
tinued for many days together, are very injurious: and the 
local applications require to he stimulating. Among :! 
ointments may be mentioned, basilicoo ointment, liouland's 
cerate, red precipitate ointment, white precipitate ointment, 
and tar ointment. These must he chanced from time to time; 
for no one application will continue to do good for many 
consecutively. Great cleanliness should be i and the 



HEALING OF ULCERS. 341 

part should be well washed with Castile soap, water and 
sponge, before each dressing. Sometimes the ulcer will not 
tolerate unctuous applications of any kind, but shows a dispo- 
sition to become irritable under their use. Mucilaginous or 
astringent washes must then be substituted. Of these, some 
of the best arc, decoction of slippery-elm bark, decoction of 
oak bark, and solutions of the sulphates of iron or copper in 
the proportion of fifteen or twenty grains to the ounce of 
water. 

When the bottom of the ulcer is entirely without granula- 
tions, perhaps little can Ik- gained by any additional stimula- 
tion; but when filled with such as are loose and flabby, if the 
astringent washes do not alter their character, it is best to 
dust them every two or three day* with red mercurial pre- 
cipitate, or with a little burnt alum. This last article i^ a 
very mild caustic, when applied to new-formed parts, and a 
powerful astringent under all circumstances. It is prepared 
by placing a lump of common alum on an iron shovel, and 
placing it over the lire. It melts in its own water of crystal- 
lization, and the heat must be continued until this water boils 
off; and the remaining fioerj powdered, is the burnt 

alum used bv suiL r < <»ns. When the sore contains the little. pale, 
cartilaginous granulation! above mentioned, some still more 
i i ul applications are required; and the best of these is 
the mild mineral caustic, (lunar caustic or nitrate of silver) 
which may he freely applied to the whole BUrfece, and re- 
; d, ifneo I days in succession. Surgeons some- 

tinx - resort to still more powerful measure -. and rut away the 
thickened edges with the knife, or burn them off, together with the 

bottom <it" the ulcer, hv means <>\ the strong vegetable caustic. 
Ulceration in general is a modification ot the termination of in- 
flammation by suppuration. 

When an ulcer of any class has been regularly filled by 
granulations, these sometimes become exuberant instead of 
healing over; and they then rise into what is called proud Jiesh. 
This must be repressed by the free application of Peruvian 
bark, burnt alum or lunar caustic, according to the obsti- 
of the growth; but in using the two last named articles, 
care must be taken to prevent their touching any part which 
has pot risen above the natural height of the surface, or any 
part upon which the thin, white, or glossy membrane which 
forms new skin, has begun to appear. 

Instead of the thin membrane which marks the proper pro- 
cess of healing, we sometimes observe the surface partly co- 
vered with a thicker, opaque, white, spongy looking film, 
which often separates in flakes, from time to time, and shows 
no disposition to dry. Whenever this is the case, the ulcer 



342 MALIGNANT PUSTULE GANGRENE OF AGE- 

should be covered with the dry dust of chalk, or, what is better, 
the carbonate of zinc, over which we may lav a simple rag of 
muslin. 

Indolent ulcers, with a surface constantly moistened 1 
iluid thinner than pus, but which are not painful, will often 
recover under a constant covering of the dust of chalk, or un- 
der a dressing of simple dry lint; and 1 have known some of 
the most obstinate to be happil; d in their condition by 

being left uncovered, .and entirely I to the stimulant 

and drying effects of air for twenty- ether. 

When an ulcer shows a disposition to form ;i scab, tin- should 
never be disturbed unless pus collect beneath, or unless the 
hardness and contraction of the scab prove very irritatu 
the surrounding parts. In either of th< it may I 

parated by one or two bread and milk poulti 

Though inflammation i^ said to terminate in >e or 

mortification, the mortification often - the imlammation. 

This is the case in the malignant pustule, ill ; old 

men, and the dry gangrene from e iting br< ad which 
spurred i j ot 

The malignant p ttett tl is b ran e; but is begtnnii - 

appear in this country. It » contracted in the si 
ner, by carving or opening th< of diseased cattle'. It 

begins by a small spot of mortification, occurring somewhere 
on the extremities, (generally the upper.) without pain or 
warning. It spreads very rapidly, and soon becoi rcled 

with a ring o( horribly painful inflammation. But oi 
is known for it, and it will certainly prove fatal if tin 
be not applied very promptly. The whole pustule witl. 
inflamed ring around it must be entirely ed with 

table caustic, or the white hot iron; and the part should 
be dressed with bread and milk poultiee until the CSC bar I 
away; alter which it is treated as a simple uleer. 

The gangrene of old m invariably in the I 

advances up the leg, and involves the whole thi \ the 

member. It is supposed to be caused by the Oflsification of the 
smaller arteries. Life may be supported till ass 
kained, by generous diet, keeping the bow< a\*\ mod- 

ly administering wines and cordials. Amputation is th< 
medy: but this cannot be attempted until the pi the 

disease is arrested, and nature att< 
then; the large arteries are closed 

beyond the mortification; so that the operation must be per- 
formed high up; and the chance of l»oth 
on account o( the debility of the patient, ami the fiequ 
with which the ossification is found extended to all the -mallei 
vessels of the limb, or, perhaps, the whole b 



GANGRENE FROM INTERNAL CAUSES. 343 

The rare and curious disease, called dry gangrene, occurs in 
persons of all ages. It begins at the finders or toes of one or 
more limbs, ailects the whole thickness of the member, and is 
progi The part dies and shrivels, without producing 

much smell. The principal blood vessels are closed iar above 
the termination of the gangrene. Amputation is necessary, 
with the same precautions as in the last named disease ; and 
the chance of success is very slight, for nearly similar reasons. 

Gangrene from excess of inflammation occasioned bij internal 
and cxmttitutional com* s, may extend to the whole thickness of a 
member, or be comparatively superficial. In the former case, 
amputation will be n< ; in the latter, it can seldom 

be required. This form of gangrene ifl progressive : and 
the V4 nd its limits Amputation is. there- 

fore, liable to the restrictions and risks mentioned in speaking 
of tin- ae of old persons, and the dry gangrene; but in 

this form, when the line of demarkation between the living 
and the dead parts is once dearly marked, the chances of 
succe astly greater, unless the patient be reduced by 

disease to an extreme degree of feeblea 

In the treatment of the form of gangrene under considera- 
tion, indcpcndentlv of the | for the relief of the 
general disease which causes the inflammation, and in addition 
to the usual measures tor maintaining the strength of the pa- 
tient and retions in good condition, as laid 
down under the head of suppuration, w<_ have local measures 
for arresting the progr es s of th< ae, which are of little 
avail in the preceding varieties. The most powerful of these 
is a blister, applied all around the line where the mortification 
This practice was strongly inculcated by the late 
celebrated Dr. Phytick. Its action obviously results from the 
relief given to the capillaries in the immediate neighbourhood 
of the gangrene, by the effusion caused by the blister. 

A great variety of poultices have been recommended in the 
treatment of gangrene; and some of them. the fer- 

menting and charcoal poultices, have been regarded as almost 
specilic in their action by many. But, excepting that it is 
proper to apply gentle stimulants to the weakened vessels im- 
mediatelv in contact with the dead matter, and that it is agree- 
able to check the fetid odour of the decaying parts as much 
as possible, there appears no very valid reason for modifying 
a poultice merely on account of the neighbourhood of dead 
matter. The charcoal poultices are dirty, and the fermenting 
ones are troublesome and very disagreeable. We would there- 
fore recommend, in domestic practice, a simple bread and 
milk poultice, when the extent of the disease is small, and a 
poultice of Indian meal and water, dusted over with powdered 



o44 GANGRENE FROM PRESSURE AND COLD. 

Peruvian bark, when it is great. If the cinchona be not pro- 
curable, prepare the poultice with a decoction of tanner's 
bark, or the bark of the dog-wood,* (cormts fiorida or ceracea.} 
To remove the terrible foetor, the dead part of the limb may 
be wrapped in cloths wet with pyroliimeous acid, and sur- 
rounded with coarsely powdered fresh charcoal, these appli- 
cations being frequently renewed. 

The probability of recovery in cases not requiring amputa- 
tion, depends very much upon the strength of the patient, and 
his ability to bear the exhaustion of a terrible discbarge during 
the whole time of the separation of the dead matter and the 
healing of the cavity left by its decadency. To increase the 
chances, the tonic measures and diet directed in case of 
fuse suppurations from abscesses should be carried as far as 
the general condition of the patient will warrant. 

(fangrtnt from pressure, that dreadful aflliction of the 
bed-ridden, is progressive only so far as the can* il pr gri ■ 
and its extension i be moment that the | 

moVed. There is no reason to believe that the blood vessels 
are clogged with coagvb for any distal) 
of the gangrene. The nsoal seats of this kind* of [ e are 

the sacrum, the nates, the hips, the harks and points of the 
shoulders, and — in mismanaged fractures of the leg or thigh — 
the parts over the tendon of the h 
the perineum. The preventive trcatm 

frequently the points of pressure, (except in lure, 

where the pressure must be smoothly applied, and made mo- 
derate in degree,) by means o( down cos! 
changes of position, and. in hospitals, 
Fomentations with cold brandy, or wbil to fortify the 

part; and, after gangrene has occurred, they hasten the - 

ration of the sloughs. The best poultice, in sir! - one 

of plain bread and milk; or. if the general debility be 
great, a little hark may he added. 

Gangram from CM — Thh d principally in the 

ears, nose. lips, chin, and extremities. It alVects the whole 
thickness of the part attacked, and generally requires amputa- 
tion, to prevent the irregular cicatrix resulting from a natural 
separation of the parts. It is very rarely ve, and il 

ver so to any great extent. There is no reason br believing that 
the circulation in the vessoh ia embarrassed far beyond the 
limit of mortification. The line oi demarkation between the 

• We mean the tree called dog-wood in the middle states. The name i» a 
dangerous one, for it is applied very differently in different places; and we ire 
told that it is used at the north to signify the "most poisonous of the sumacs, 
the rhus yernix ! 



GANGRENE FROM MECHANICAL INJURIES. 345 

dead and living parts is readily, and, in most instances, speedily 
formed. In these cases amputation is, therefore, beset with 
none of those dangers which attend it in most of the preceding 
varieties. The prospect of cure, under the proper general 
treatment, is good; for the patients most subject to these acci- 
dents are men of vigorous and hardy constitutions. We have 
known of more than one instance of natural cure, without am- 
putation, after the loss of both feet, where professional aid 
could not be obtained, and where even the diet was ill adapted 
to support the patient under an exhausting discharge of pus. 

Gangrene fi\ mical Injuries. — When the mortification 

occurs from tfa - of inflammation produced by mechani- 

cal injuries, the injuries are generally much more extensive 
than the mortification; and for this reason alone, the gangrene 
jucntly progressive. The uniform ill ellects of amputa- 
tion in some of the preceding varieties, has induced many sur- 
to proscribe the attempt to amputate before a clear line 
of demarcation is trac absorbents, between the dead 

and hiving matter: or, at all events before the progress of the 
mortification is arrested. Hundreds of lives have been sacri- 
ficed to the < on and sympathetic mischief resulting 
from severe injuries, during tip' delay occasioned by this ill- 
founded opinion. We cannot allow even this opportunity to 
past without stepping aside, for a moment, from our legitimate 
track, to point out sore of the erroneous character of 
the rule to those practitioners wh ion removes them 
from the opportunity of widely extended surgical observation. 

Traumatic gangrene, (the technical title of the present va- 
) t!iou'_ r h frequently pi . when un- 

comp rosly injured at the time of 

nt. The emban of the circulation from co- 

agulation never appeal- sphere much more extended 

than the limits of toe injury. The principal causes of morti- 
fication, or ulceration of the slump, and consequent death, after 
amputation in other forms of gangrene, are either the vitia- 
tion of the constitution by previous disease, or the morbid con- 
dition of the part involved in the operation produced by simi- 
lar causes. Now, in traumatic gangrene, the constitution is 
usually sound, until the health is undermined by the conse- 
quences of the injury itself; and, especially, by the irritation 
produced by the morbid condition of the parts; which are so 
altered by the accident and the subsequent inflammation, as to 
be liable to fall under the progress of the gangrene. So much 
for the dangers dependent on the general condition of the 
health. As it regards the state of the part operated upon, no 
surgeon in a sound state of mind, professionally speaking, would 
attempt to pass his knife through parts seriouslv altered from 

-11 



34(i INJURIES PRODUCING COLLAPSE. 

health. He goes above the injury; or, at least, above the se- 
vere impression which it has made ; and there operates upon 
parts nearly, or entirely, in a sane condition. The causes of 
disaster, in amputations during the progress of other 
grenes, are therefore absent in the commencement of trau- 
matic gangrene; and we are confident that the risks of an 
ulceration or mortification of the stump, as well as the danger of 
phlebitis, or metastatic abscesses, — the usual causes of death. — 
are much greater when we wait for the line of demarkation, 
than when we operate as soon as possible after the full 
blishment of reaction. 

Cases occurring in persons previously affected with serious 
ill health, are of course exceptions to this law, and one other 
caution seems advisable here. A livid appearance of the 
skin, and the formation of collections of bloody scrum beneath 
the cuticle, after bad fractures and contu-i- • proof of 

gangrene; for we frequently tee thai state of tbingi on the 
surface of limbs, in which the si:_ r ns of circulation beyond the 
injury arc plain and obvioi: with- 

out another unpl mptOBL 

In traumati' - not to require or ad- 

mit of amputation, the it should be similar to that 

scribed in gangrene from excess of inflammation produced by 
internal caua 

Termination* of inflammation coupled with colhr f -.--\\ 
completed our remarks upon the terminal ntlamma- 

tions of moderate extent, it ■ time to add a few wordi upon 
those which arc 10 genera] fti to produce collapse. The 
frequent of these accident :lt from burns and 

scalds, which may therefore be taken as the tvju ; tl 
there arc others of similar character occasioned ! 
both internal and external. 

The condition of things immediately foil 
of this description, is widely dii m that p it the 

commencement of tion. The vu\ exu nt and mi; 

of vessels injured, renders it impossible that the rapid:; 
circulation should be materia 11 v increased it for the 

whole mass o( circulating thud is insufficient to keen up a 
swift current through so many dilated Teasels, whil- 
ing a sufficient supply to the other i ad the b 

rally. This impossibility is rendered more \ natu- 

ral consequence of all extreme 

one which has been already described in the chaptc r on pi 
logy. This is the concentration of the vital energies upon the 
organs most essential to life, which pr 

ment of the blood vessels of the brain, b nacb. and ihe 

portal system generally : thus removing a 



INJURIES PRODUCING COLLAPSE. 347 

other parts of the body, oppressing and checking the action of 
the heart, and leaving the surface, where uninjured, pale and 
contracted. 

In this condition, the inflamed part is indeed reddened, but 
the colour is not the florid hue of lesser inflammations, but 
wears a purple, dark, or venous aspect. The temperature 
is not materially increased, and is often found even below the 
natural standard ; for the main source of animal heat is cut otK 
For the same reason, — (he tardiness of circulation, — the sensi- 
bility of the superficial nerves is diminished, instead of being 
increased. But little positive pain is felt, and although there 
is sometimes a terrible burning or tingling sensation, yet, in a 
majority of cases, the patient complains of nothing but 
cold, and trembles like one in the chill of an ague. It is curi- 
ous that the extent of a superficial injury is much more effect- 
ive in producing collapse than its severity. I have seen many 
of the muscles of both noyed by hot sand poured out 

from a bursted brick kiln, yet the patient suffered no collapse, 
and lived for many weeks; and again, 1 have seen a man who 
had been completely surrounded by high pressure steam, im- 
mediately on its escape, in profound collapse and violent chill, 
though the scald had not raised a blister on any part of his 

Ja.* An individual but slightly burned over more than 
lalf hi- surface, almost al. j while one who has been 

rely burned over but one-third of bis person, stands 
drer chance of re< 

In thf state above described, it i< evident that the applica- 
tion of cold would be extremely improper. It diminishes still 
farther, the alrea< enl vitality of the surface, and in- 

- thf determination of b of life al- 

ready oppressed with I id. We have seen a surgeon 

wild enough to direct cold effusions on one of the most exten- 
ttded with collapse; but almost immediate death 
ived the correctness of the doctor's theory ! Equally 
idle, to use no har>hcr term, would be the attempt to employ 
local depletion, or low diet, in cases of this character. In 
\' tv had accidents of this nature, the labour of reparation, if 
attempted, keeps the system constantly depressed. The reac- 
tion is imperfect, and when fever occurs, it is of a low type, 
and attended with great danger of inflammation of internal 
organs. 

The general treatment throughout the case must be of the 
tonic and stimulating character, to support the patient's 
strength, and equalise the circulation; care being taken to 

" It is a remarkable fact that steam, on its first escape from very high pres- 
sure, does not scald. The farther the subject is removed from the orifice, the 
more serious is the effect of the heat. 



348 INJURIES PRODUCING COLLATE. 

keep up the natural secretions by suitable purgatives, such as 
eight or ten grains of rhubarb, occasionally combined with 
five of calomel, and the terebinthinic mixture given in ihe 
dose of a table-spoonful every three or four hours. The sti- 
mulants given should be of a nature to act on the skin. The 
camphor julep and wine whey, are among the best. If there 
be great restlessness and vigilance, an occasional dose of a 
tea-spoonful of Hoffman's anodyne, will . «t relief. 

Acidity of stomach may be checked by ten grains of carbo- 
nate of soda, dissolved in a wine-glassful of water. Sick 
of stomach may be relieved by the spice piaster, with cold mint 
tea, or the horse-mint tea, {monarda punctata ;) and thirst, by 
lemonade, cremor tartar water, and ice. When suppuration 
is extensively established, great benefit frequently follows the 
use of the decoction and tincture of bark, or the best wine 
bitters. 

The local treatment must also be stimulating. The appli- 
cation universally employed, in the first instance, in very 
extensive burns and scalds, is the Kentish ointment: a mixture 
of lard and spirit of turpentine: which, far from giving pain, 
is peculiarly soothing in its effects. 

The above directions are intended for the treatment of 
in which free reaction never becomes established. 
When the pulse rises, and the swelling, heat, and pain of the 
part increase, the proper treatment should be cautiously and 
slowly approximated to that prescribed in inflammations of 
more moderate extent. 

These injuries very rarely terminate in resolution; and then, 
only in cases of the mildest character. When the mischief 
is more severe, the cuticle is lost over part, or the whole of 
the burned or scalded surface, and the most troublesome ul- 
cerations of the true skin are almost sure to follow. When 
•still more the true skin itself is destroyed, often toge- 

ther with deeper seated parts. We bave tben. actual and in- 
stantaneous mortification, preceding the inflammation; but the 
gangrene never shows sition to ictly 

local. The ulcers are now proportionally more unmanagea- 
ble, and are followed by terrible contractions of the cical 
when healed, often producing dreadful deformities, and some- 
times destroying the use of the neighbouring joints. 1 
deformities are not always incurable — surgery has manv re- 
sources for their relief, in the way of serious, painful, and 
protracted operations; but very few surgeons in this country 
have as yet been willing to attempt much in tl. i The 

subject, however, attracts more and more attention d; 

Having completed our somewhat ample remai k lam- 

ination, in general, we must trust mainly to the intelligence 



ULCERATION OF THE EYE-LASHES. 349 

of the reader, in applying the principles and directions to par- 
ticular cases. Our remarks en certain peculiar inflammato- 
ry affections will be few, brief, and confined chiefly to those 
points in which the nature or treatment of the disease differs 
from that laid down in the preceding portion of this section. 

Of the Sty. This is an inflammation on the edge of the 
eye-lid, surrounded by much hardening, and often inducing 
inflammation of the front membrane or conjunctiva of the eye, 
and consequent intolerance of light Sties are often vqvv te- 
dious and painful, and there is apt to be a succession of them. 

The sty is occasioned by a clogging of the outlet of one of 
the little glands, which furnish* > or gummy matter to 

the edge of the eyelid. The secretion then collects and forms 
a little sac, which inflames, but rarely if ever suppurates freely. 
Sometimes it may be much benefited by the application of 
a leech or two, after which the eyelid may be rubbed with 
Goulard's cerate; and if the interior of the eye be inflamed, it 
should be relieved by frequently dropping into it a single 
drop of a solution of the pith of sassafras, made by shaking 
four or five inches of pretty thick pith, or a proportionate quan- 
tity of that which is liner, in a four or six ounce vial full of 
pure water. To drop this, let the patient place his fore finger 
over the mouth of the vial, and looking directly up to the 
ceiling, let him bring the etlge of the vial close to his open 
eye: by raising his linger a little from the mouth, and then 
dosing it again immediately, in this position, a single drop 
will fall directly on the ball of the eye. When there is any dis- 
position to point, or form a yellow spot on the edge of the 
eyelid, it should be picked open with the point of a needle, 
and the yellow crust which soon forms on the spot, should be 
kept soft by very frequently washing the gently closed eye- 
lids with warm water and plenty of Indian meal. A disposi- 
tion to form a succession i may often be checked by 
wetting the palm of the hand with brandy or whisky, and 
subjecting the open eye, every day, to the fumes alone, by 
holding the wet hand over it. 

Ulceration of the eye-lushes. There is a troublesome 
scurfy or scaly ulceration of the edge of the lid which destroys 
the eye-lashes, after surrounding the base of each hair with a 
kind of honey-comb crust. 

To relieve this, prick away all the scabs carefully with the 
point of a needle; and then with the back of the point of a 
penknife, spread a little citron ointment, mixed with its own 
bulk of lard, over the ulcerated surface, pushing it very care- 
fully between the hairs, f)ut avoiding all contact between the 
eye and the salve. In half an hour, wash it off with Castile 



350 FOREIGN SUBSTANCES IN THE EYE. 

soapsuds on a soft rag — and repeat the application every 
morning;. 

Foreign substances in the Eye. Particles of dust, saw dust, 
sand, the grit from grindstones, &c, are very frequently caught 
between the eye-ball and lids, where they give intense pain, 
and if not immediately washed out by the flood of tears which 
they create, they produce excessive and sudden inflammation. 
They must be removed as soon as possible. If of a dark co- 
lour, and above a microscopic size, they may always be 
by raising the upper or d» the lower lid, drawing it 

off at the same time from the ball by means of the la 
directing the eye to be rolled in various directions. After a 
few trials, we almost always see the offensive particle-, 
can readily remove them, either by blowing with the breath, 
or scooping them up with the eye of a silver probe or bodkin, 
or one handle of a delicate pair of ladies' 1 I— in The 
bears the contact of these smooth solid substances perfectly 
well; and if gently used, they in whatever. As 

soon as the particle is .a drop of the solution of pith 

of s;i- iould be dropped into I it should be 

covered with a handki r a few hours. When the mote 

cannot be me may be slippc . 

tween the upper lid and the ball, and the lids closed. The 
stone will immediately commence travelling round 
pushing the mote from pin . till the I 

approaches the opening, ami is washed out b) tb< The 

stone may he left in th- an hour: as it pj » un- 

pleasant sensation. Every family should he 
veral of these useful little i, which are told 1 ■;. 

apothecaries. They are the opercula or mouth-] mall 

marine shells, worn very Bmoolh I 
on the beach in certain countries. They ihould be 
clean, and preserved from the con! 

vinegar or lemon juice will du pail them. Their 

motion in the eye nod by that of the ball and lida 

they do not drop out the moment t 1 
be pressed out by a slight touch o\ tin 

Sometimes pieces ( .t iron. BO BtlDH 
hie. are driven forcibly into the membranes, or even into the 
cavities of the eye. In the lat 

cuated in consequence of the - the wound, the iron is 

absorbed by the fluids, generally without producing ma: 
inconvenience: hut when the particles stick in the outer mem- 
branes, they give intolerable pain. 1 I this 
kind happen to turners, machinists, and bla 
ways require (he aid of a surgeon. Fortuoatelj 1 aid 



INFLAMMATION OF THE EYE. 351 

is almost always promptly attainable in the neighbourhood of 
the establishments of these artisans. 

But 1 have frequently seen milder cases in distant country 
situations, where domestic relief is often the only dependence 
for many hours. On attempting to work rusty and neglected 
iron pump-handles, the axles of grind-stones, and the chains of 
well-buckets, we frequently see thick showers of fine sharp 
particles of rust shot off in all directions with great force by 
the friction. This is the general cause of the accident on dis- 
tant /arms, and it is very rarely understood. When, after 
standing near either of the domestic machines just men- 
tioned, while in action, a patient suddenly complains of great 
pain in the eye, an inability to keep it open, and a profuse 
flow of tears, we should at once examine the organ with ex- 
treme care: and if a minute speck of a black or brown colour 
n in the clear or white part of the eye. which does not 
move upon being gently touched with the point of the finger, 
we arc sure of < ur case. A person with linn nerves, a steady 
hand, and a tolerably delicate touch, may safely pick away 
tin; mote with the point of a I die, provided it be not 

Obviously sunk beneath the surface. In this case, he must use 
freely the solution of pith of 1 • and leave the treat- 

ment to a sin -.on, be his arrival late or early: for, by attempt- 
ing too much, the eye might ho evacuated 

As soon as the point of tin- needle has obviously removed 

any portion of the mote, the operator may bo assured that the 

whole is dislodged] even though a brown <>r dark spot remain. 
Motes of this kind are hard, and do not come away piece-meal : 
and they always produce an appearance which may prove a 
source of dan ror, if the fact he overlooked. They 

communicate to the tissues all around them a stain of their 
own colour, which often continues (or weeks alter the cause is 
removed. The consequences of attempting to pick away this 
stain need not be pointed out. 

frnfiamnuUion if (lie Eye, The human eye is an organ so ex- 
tremely complex, that it is subject to a very great variety of 
diseases, some of them destructive to the organ itself, and others 
even to the life of the patient. It is, therefore, with fear and 
trembling that we attempt to address ourselves to unprofes- 
sional cars upon this critical subject. But after having seen 
the eye tilled with powdered alum, when in a high state of 
inflammation, — with sand, to grind oil a film mechanically, — 
with spirits of turpentine, to relieve a burn, &c, we cannot 
but feel that the few remarks we are conscientiously warrant- 
ed in making, may be productive of more good than harm. 

Acute inflammations of the eye, when at all severe, are 
commonly attended with violent reaction. The fever is gene- 



352 INFLAMMATION OF THE EYE. 

rally open and high, and the case requires the most vigorous 
general, as well as local treatment. 

'The lancet should be freely used when the constitution of 
the patient will bear it, and in those terrible inflammations of 
hot and sandy countries, sometimes, though rarely witnessed 
in other situations, which produce suppuration in the course 
of a few hours, it is often advantageous to bleed, even to faint- 
ing. The diet should be as strict as possible, and both eyes 
should be positively protected from light. Saline purgatives 
should be given freely and frequently, as the patient's strength 
will bear it. 

When the iris is inflamed, the state of the organ may be 
known by the formation of a well defined, narrow red 
round the circumference of the clear part of th red- 

ness evidently shining from deeper parts, through the white 
membrane in that place, where it is thin;) by a reddish, dt 
or unnaturally mottled appearance of the coloured membrane 
of the eye; by an unusual smallness, immobility, and, some- 
times, irregularity of the pupil; by pain d< <1 in the 
ball of th mveryintJ -ation of con- 
striction and pain across the front of the forehead, above the 
eye-brows. In this state of things, the mouth must be touched 
with mercury, as rapidly as possibl a pill of half 
a grain of calomel and the fourth of a grain of opium, four or 
six times a day, while the general treatment above described 
is pushed with vigour; omitting all purgatives, for fear of re- 
tarding the action of the mercury. The moment the gums 
appear a little sore, and the quantity of saliva begins to be in- 
creased, the mercury must be intermitted; ami, if the saliva- 
tion threaten to run high, a gargle of borax and sage tea, and 
a purge o( sulphur and cremor tartar should be given. The 
operation should be followed by the occasional exhibition of 
a mercurial pill whenever the salivation appears likely to 
cease; so as to keep up a gentle action on the mouthfor seve- 
ral days. This is almost the only hope of safety in iri 

In inflammations of the front membrane of the eye. which 
arc much more common, the whole surface of the inside of 
the lids and the white part of the ball arc generally reddened. 
The litis are swelled and puffy, the eye watery, and the e< _ 
of the lids, in mild cases, are generally agglutinated in the 
morning. There is intolerance of light, but not so mark* 
it is in iritis. The pain is commonly superficial, and is of the 
smarting and burning kind. The general treatment being 
carried on as vigorously as the violence and rapidity of the 
case seem to require, the best local mcasur 
the infusion of the pith of sassafras and weak lead water. Cold 
applied to the lids gives great relief. 



INFLAMMATION OF THE EYE, 353 

In bad and rapid cases, the swelling becomes very great; the 
external membrane of the eye becomes thickened and granu- 
lated, rising up until the clear part looks as if seated at the 
bottom of a blood-red cup, and the thickened membrane some- 
times actually protrudes from the lids. In this condition the 
eye pours out an enormous quantity of pus. If the disease 
continues unchecked, the external lining of the clear part be- 
comes cloudy and opaque, or even red. This produces a film 
which seldom disappears entirely, and often produces incura- 
ble blindness. These cases occur, occasionally, in all places, 
and at all ages; but they are most frequent among children in 
temperate, and adults in tropical climates. 

In addition to the general treatment already laid down, the 
author of these pages introduced into the practice of the Penn- 
sylvania Hospital, in 1819, a plan of local treatment, formida- 
ble in appearance, but perfectly safe, even in popular hands, 
under the circumstances described, and one which has never 
failed, in his hands, to conquer the disease. It consists in ap- 
plying three or four American leeches directly to the ball of 
each affected eye, avoiding the clear part. When the leeches 
are two-thirds full, cut oil' a quarter, or half an inch of their 
tails with a very sharp knife, razor, or pair of scizzors, dis- 
turbing them as little as possible by the operation. They will 
then continue to suck for a long time, evacuating themselves 
it as they fill. l( their pertinacity exceed the bounds of 
patience, they may be made to fall off quickly by touching 
their backs with a little dry table salt. This operation never 
produces any evil consequence, though the unpractised ope- 
rator is often extremely alarmed, next day, to find the whole 
surface of the eye of one bright red hue, in which no vessels 
can be discovered! This appearance is occasioned by an ef- 
fusion of blood from the leech bites, poured out beneath the 
membrane, which is nearly transparent, even when inflamed. 
It is of no consequence whatever, and disappears in a few 
clays by absorption, sometimes passing through the various 
shades of colour usually seen in bruises. After the operation, 
the eye should be covered with a light, cold bread and milk 
poultice, containing a little sugar of lead. This practice, with 
the exception of the mutilation of the leech, has been since 
introduced, extensively practised, and publicly advocated by 
a distinguished surgeon of Dublin. To show the safety of the 
leech, as an application to the ball of the eye under such 
unfavourable circumstances that none but a surgeon could 
safely presume to employ it, I will mention that in one case 
of violent iritis threatening the destruction of both eyes long 
before salivation could be induced, I ventured, as a forlorn 
hope, to apply three very large leeches directly to the red 

45 



354 ULCERATIONS AND FILMS 01 THE EVE. 

ring already described, where they bit entirely through the 
white coat of the eye, and drew the blood directly from the 
vessels supplying the iris. Strange lo say; though the pupils 
were contracted to the size of the heads of large pins, and 
nearly square, while the iris wore all the appearances of im- 
pending disorganization; the relief of the attack, under this 
treatment, proved both immediate and complete. 

Ulceration of the Cornea. — This alTection is noticed chiefly 
to warn the domestic adviser to seek surgical advice as quickly 
as it appears. In this affection, the eye is very intolerant of 
light, and watery; and, on examination, we perceive, on some 
part of the clear portion of the eye, a small, rounded, or ir- 
regular depression; and two or three well marked n 
are seen meandering from some point of the white of th< 
across the field of the clear part, toward this depression. The 
danger of loss of sight is imminent; and, although surgeons 
possess many resources for the Bi f the 

case, yet all that can safely be done by unprofessional fr. 
is, to relieve pain by the use of the solution of pith ot 
or well filtered watery solution of opiu;. lode all I 

and, by practising, in moderation, the means of general d< 
tion laid down at the head of this article, to delay the pro- 
gress of the case until aid can be obtained. 

Films on the Eye. — The disease called pterygium by 
gcons is very common, and only occasionally I jble. 

It then appears as a triangular opaque membi lied with 

many long red \\ larp point slowly creeping 

on to the clear part of the eye, generally from the inner side, 
and crowned with a little brown lump at i Its 

growth is not inflammatory; but it frequently bee 
flamed with cold. Astringent -. such as sulpha) 

copper, three grains; sulphate of zinc, (bur 
of lead, six grains to the ounce of watt , 
it to shrink and disappear, for a time; but, if they give U 
ness to the eye, they must be omitted. When this affection 
encroaches permanently upon the sight, we perform, for its 
relief, certain surgical operations, neither painful nor dai 
ous; but troublesome, and of rather tloubllV 

Opacity of the cornea, or clear part of t ; d those 

films which arise from purulent ophthaln. 
entirely beyond the reach of i } but time itself often 

does much in tho- e not utterly hopeless; and 

we seriously recommend the reader not to endeavour to i 
the change by art, unless by the adviv ikilful: 

but, by all means, let him >hun the absurdil 
quackery, and the false pretences of itinerant oculiJ 
these, what little sight remains, is almost sure lo be lost. 



FOREIGN BODIES IX THE EAR. 355 

Nearly all the chronic affections of the eye, including rheu- 
matic and scrofulous inflammation, will endure to wait until 
the best advice can be obtained: the deeper seated inflamma- 
tions are beyond any popular assistance, except such as may 
result from the rational application of the general principles 
laid down in the commencement of this section, and we have 
now said quite as much of diseases of the eye as we can say 
conscientiously in a work designed for families. 

Foreign bodies in the Ear. Insects occasionally make their 
way into the external ear, particularly in children, when lying 
on the grass. They sometimes produce horrible torture by 
irritating the drum of the ear, and parents are troubled to 
know how to dislodge them. No process is more simple. — 
Let the child recline with the opposite ear upon a pillow, 
and fill the affected one with sweet oil. There is no insect 
that will not perish, or make good its retreat, when this me- 
thod is pursued. 

Solid substances are frequently pushed into the ear by chil- 
dren; where, if large, they sometimes occasion much inflam- 
mation, and become firmly wedged by the swelling. Great 
danger of destruction to the drum and small bones of the ear, 
results from awkward attempts at removing such substances, 
by which they are driven still deeper into the canal. If the 
foreign body have any visible projecting point, of which a 
firm hold can be taken, this may be seized by forceps or pin- 
cers, and the body removed directly; but when the substance 
is rounded, or formed with many faces, or extremely smooth 
and cylindrical, it is very wrong even to attempt its removal 
by any such means. Cherry stones, apple seeds, common 
nets, bugle beads, and pieces of red coral, furnish 
main i point. If we attempt to seize them in front, 

instantly Blip farther in, and endanger the drum. We 
must get behind them and hook them out, always proceeding 
with great caution. Sudden and severe pain warns us when 
we touch the drum of the ear, and then all considerable pres- 
sure in the inward direction must cease. When the foreign 
body is small in proportion to the size of the canal, it may 
generally be removed by means of the little steel ear-picker 
on the handle of the common pocket tweezers; but, when 
larger, the eye of a fine bodkin or silver probe should be 
gently curved and inserted beyond the body to draw it for- 
ward. A few drops of sweet oil, previously dropped into the 
ear, will much facilitate the operation. When a large glass 
bead, with eighteen or more polished faces, is forced into the 
ear, — an accident which we have seen rendered fatal to hear- 
ing by mismanagement, — the only sure mode of extraction is 
to pass a very fine hook through the eye of the bead, and 



356 INFLAMMATION OF THE EAR. 

catch a purchase upon its farther end. A fine darning needle* 
with its temper entirely destroyed by the candle, and curved 
at a right angle as closely as possible to the extremity of the 
eye, furnishes the best extemporaneous instrument for such 
extraction. 

Ear-ache and suppurations of the Ear. The diseases of 
the ear are intricate and little known, and it would be idle to 
dilate on them here; but a few words may prove useful in al- 
leviating pain. 

There are media of nervous communication between the 
teeth and the ear, through the distribution of the fifth pair of 
nerves. When, therefore, we find a settled, obstinate pain in 
the ear, either constant or irregularly paroxysmal, without ob- 
vious cause, without much detriment to hearing, or any swell- 
ing or purulent discharges, we should examine the condition 
of the teeth and gums, and remove all sources of irritation in 
that quarter. 

Swellings and suppurations of the lining membrane of the 
ear generally result from cold. Ti. be either internal 

or external to the drum; but, in either case, the severe throb- 
bing pain is best relieved by warmth; anil one of the best 
modes of applying warmth is as follows: — Take a root of the 
garden garlic, and roast it pretty thoroughly; then separate 
the cloves; and after syringing or washing the ear with I 
tile soap, or milk and water, made pretty warm, heat one of 
the cloves, and taking a little piece th a large 

knot on one extremity and a needle at the ot - the 

thread through the clove, from the great tou -mall end, 

and draw the knot just within the surface: then introduce the 
clove into the ear. large end foremost, and as warm as it can 
well be borne, leaving the end of the string dependent Change 
this application every few hoi | the ear, if i 

sary. 

Frequently in children, and sometimes in adults, ulcerations 
occur in the external ear, and these may even occasion dis- 
eases of the bone, pieces of which are often discharged from 
the sores; ami sometimes the affection has been known to 
prove fatal by reaching the brain. The dil 
cases are fetid, and the dil m indication of con- 

stitutional ill health. All that can be done by the domes- 
tic practitioner, is to keep the ear as clean as p 
ringing; to relieve pain by the garlic cloves, when violent 
inflammations occur: ami to attend to the condition of the 
bowels and general health. Free air, and tolerably good diet, 
are generally required, when there is no threatening of disease 
of the brain. 

llccrations of the Mouth. There are several forms of 



, GUM-BILES — URINARY SUPPURATIONS. 357 

small ulcerations of the mouth which give great inconvenience, 
but rarely lead to a consultation with a physician, except in 
large cities, or in cases of more serious disease in which these 
ulcers appear merely as a symptom. They are seen on the 
edges of the tongue, the gums, and the inside of the lips or 
cheek. They are small, irregular, superficial, often numerous, 
very painful, sometimes surrounded with many enlarged ves- 
sels and a small ring of bright red hue. Their suiface is co- 
vered with a closely adherent white coat or spurious mem- 
brane. Some of these are herpetic, others are aphthous. 
They often prove obstinate, because they are caused by a bad 
condition of the bowels. 

They may be seen, occasionally, at all the other mucous 
orifices of the body, and even on the brown areola round the 
female nipple. 

The favourite applications to these ulcers, are borax, and 
salt-petre applied solid or in solution; but the treatment 
which we have found most generally successful, is the satu- 
rated solution of sulphate of copper* The sore should not be 
left under the impression of this agent for more than five mi- 
nutes, when the mouth should be well rinsed with cold water. 
The application should be repeated every day or two. It fre- 
quently happens that these sores, when situated on the cheeks 
or lips, are rendered much more painful by their pre 
upon the teeth, or by the irritating effect of impurities about 
the gums. This may be at once relieved by roasting a fig, 
splitting it in half, and applying the soft side of one piece 
next the sore. 

(1 inn-biles. The causes and nature of these affections are 
too well known to need description. They are sometimes 
very large, and tend to break externally. They should be 
brought forward as fist ai >le by means of the hot fig 

poultice just described; and if large, should be opened early 
by the lancet, always on the inside of the mouth; for, if they 
burst or arc punctured externally, extremely disagreeable de- 
formity always results. As soon as they recover, any decayed 
fangs which may be likely to reproduce them should be ex- 
tracted; but it is generally unadvisable to perform such opera- 
tions during the continuance of the inflammation. 

Suppurations of the urinary ])ussu<r CS , Besides the dis- 
charges of matter from the male and female urinary passages, 
originating in immoral habits, there are others equally profuse, 
which arc occasioned by cold, chemical irritations, poisons 
taken internally, and other causes. "We have seen them se- 
veral times, in carefully guarded girls under ten years of age, 
and in boys even before the age of five years. It is, there- 
fore, incumbent upon the medical or domestic practitioner to 



358 URINARY SUPPURATION. 

be extremely guarded in founding suspicions of moral impro- 
priety upon such slender grounds. 

Whatever be the cause of the discharge, the symptoms and 
proper treatment are nearly the same. There is a period, 
lasting from three days to two weeks, during which inflam- 
mation runs very high, with extreme scalding in urination, 
and often intense pain, particularly at ni^ht. On the subsi- 
dence of these violent symptoms, the discharge of pus often 
becomes even more profuse, though the scalding and pain 
may have been almost relieved. After several weeks or 
months, if the case be neglected, the discharge ch.v 
dually to a pale, and almost colourlo early 

incapable of cure, and exceedingly exhausting to the patient 

During the highly inflamm ^e, the general treat- 

ment of severe inflammation, which has been already described, 
should be employe'!, led local injections used after every urina- 
tion. The best inject ion I are made of the pith of sassafras for 
males, and the slippery elm bark for females. If great pain be 
Suffered at night, apply I large bread and milk poultice, with 
opium, or one of Imps and vim 1 diluted with w 

From thirty i<> sixty dropi <>f nitre, in half a 

wine-glassful of water at bed-tim< . soothing. 

When the inflammation hai _ ', a little 

water may be added to the inj id when the pain 

and scalding an- very considerably diminished, we may begin 
to use an injection of sulphate of copper in the proportion of 
half a grain to the? ounce of the solution of the pith of sassa- 
fras. This injection produces much smartii I 
increase of the purulent discharge, soon followed by i 
diminution. The strength of the injection may be increased 
every three days, at the rate of half a grain of the sulphate to 
the ounce, until the difl be cheeked, or the strength be 

five grains to the ounce, which must not be exceeded. The 
arresi of the disci fated by the first in- 

jection, ami in Other rases, not for several v. \ - <lden 

arrest by too powerful a solution at first, may occasion \ 
serious consequences; such as swell) e in the male and 

peritoneal inflammation in th< - ngle 

caution to omit the astringent injection for ;>. I, : the 

inflammation be found decidedly ir. - by it an hour after 
the application, the practice above described will be found 
perfectly safe, if strictly followed. Once, or. at most, twice a 
day. we may use the sulphate of copper; but the plain muci- 
laginous injections may he employed as often as thev are 
found agreeable. Some person- id of the stimu- 

lating balsams, internally exhibited; but we have seldom seen 
much benefit derived from them. 



EXCORIATIONS — ABSCESSES. 359 

Excoriations about the ??iucous orifices, occasioning swell- 
ings of the neighbouring glands. All the mucous orifices 
of the body are liable to two forms of superficial ulcer or ex- 
coriation: one beginning with a little watery blister, which 
bursts and leaves a shallow sore, soon acquiring a hard- 
ened base; and the other commencing generally with a very 
small pustule, and covering itself with a soft scab. Both forms 
ry apt to occasion swellings of the neighbouring glands, 
which, if neglected, will sometimes suppurate, when they 
must be opened and treated as abscesses; but this termination 
must be prevented, if possible. The ulcers should be washed 
every morning with a saturated solution of sulphate of cop- 
per, to be removed by clear water, without friction, in about 
five minutes; and after the part has been dried, it should be 
covered with the powder of carbonate of zinc, renewed as 
often as it becomes moistened by the discharge. When the 
ulcers begin to contract, the sulphate of copper may be omit- 
ted; but should they spread or multiply Sgatn, it should be 
renewed. 

When the glands begin to swell, the patient should be put 
on a low diet] and bled, if neees>arv. He should also take a 
gentle saline purgative daily; such as the SeidlitZ powders. If 
•ell rapidly, let leeches be freely applied OVCF 
them. If still unchecked, and no signs of threatened suppura- 
tion appear, apply a blister over them. When the hardness 
of the glands continues long after the ulcerations which caused 
their enlargement are cured, a plaster composed of ointment 
of while precipitate, one ounce — camphor in fine powder, 
one drachm — and muriate of ammonia powdered, one scru- 
ple — will very much promote their absorption. 

Chafing in the creases of the folds of the groin and other 
parts. To this very troublesome affection, fat persons and 
children are peculiarly subject. It is a transformation of skin 
into mucous membrane, from the exclusion of air and the con- 
stant action of moisture, and is at once cured by keeping the 
part covered with dry pearl powder or carbonate of zinc, 
washed off and renewed twice a day with cold water. The 
powder allows the air to penetrate the fold, and keeps the part 
dry; thus restoring the skin to its natural structure. 

Chafing from friction. This source of annoyance is too 
well understood to need description. It is best relieved by 
coating the part well with sweet oil, or unsalted lard, and then 
allowing cold water to ilow over it. The interposition of a 
little lint or a piece of silk between tie inject to attri- 

tion, will prevent the renewal of the evil. 

Of Abscesses. For the general principles which regulate 
the treatment of abscesses, we refer to the pages on inflam- 



300 ABSCESSES. 

mation terminating in suppuration. Our present intention is 
to offer a very few remarks on opening and dressing these af- 
fections. 

When an inflammatory tumour has commenced the forma- 
tion of pus, the occurrence is known by a change in the cha- 
racter of the pain, which becomes throbbing and compara- 
tively dull; (we must except from this rule inflammations of 
the hand and foot, which generally throb from the first;) by 
the summit of the tumour assuming an unusual prominence, 
and a faint attempt at a conical form: by a perceptible de- 
crease of hardness in the centre; and, after a time, by the 
fluctuation of the pus when the swelling is tapped with the 
finger. 

The disposition to point or open externally is known 
decidedly conical prominence, and by a change in the colour 
of the skin, from white, to red or brown. It is rarely pi 
to allow al of their own accord; for natut 

most always effects the Dill kwardly and imperfectly. 

The thumb la the instrument commonly employed in 

opening them; bilt in timid j re the matter ap- 

ues very near tie infill, the 

spring times preferable. In very large ab- 

staining quarts «>f matt cially wl 

occur in patients much debilitated by the dif 
safest to evacuate the COOU - low- 

ing the punctures to heal in the inter\ e by 

passing the thumb lancet very obliquely through the true 
skin, before raising its heel ami plu larly into 

the cavity; so that the internal and ea i not 

correspond, ami the skin is ive to be clo- 

the desired amount of matter h 

cuation of the whole of these large collections some" 
causes the patient to sink: and thi lion of air into the 

cavil;. - the pus afterwards S . rendering it irri- 

tating, and bringing tion of the exten- 

sive sore. But, in all al ctent, the puncl 

should be direct, and the ei 

As soon as it is completed, a small portion of lint shouk 
gently inserted into the orifice to prevent it from el 
the first intention, and then bread and milk poultices should 
he applied for one or two days. The lint c with 

the first dressing, and need not be renewed. If there be much 
inflammation about the abscess, the poultices may be conti- 
nued; but if not, it is commonly best to apply some : 
ointment, such as the simple cerate, to tl 
ty, while we use a bandage, with or without moderate l 
press to keep the :>ides of the al much in con- 



RUN-ROUND WHITLOW. 361 

tact as possible, without interrupting the free exit of the pus 
as it is formed. 

In large abscesses, it is sometimes convenient to sur- 
round the dressings with bran to absorb the pus, and keep off 
the fly. 

Large collections of matter sometimes form without ob- 
vious inflammation at the spot where they appear. These are 
most frequently seen on the back or thigh, or about the anus. 
They must never be tampered with by the domestic practi- 
tioner, as both their cause and 'place of commencement are 
generally beyond his cognizance, and the attempt to open 
them often hastens the death of the patient. They may be 
connected with dil the spine or liver, though pointing 

on the shoulder or thig 

Jiiui-ruiDul. This is a disease of the fingers and toes. We 
frequently see an inflammation running round the sides and 
of a nail, commonly caused by paring too closely the 
fold of the cuticle found in that situation, or by tearing down 
a shaving of the edge of the nail. The inflammation produces 
B ring or semicircle of redness, and a very considerable de- 
gree of swelling, attended with extreme soreness and consi- 
derable pain. Suppuration speedily supervenes, and the pus 
is located between the external cuticle and the duplicative of 
that membrane which is reflected inward toward the root of 
:il. It is easily t lie skin from the 

nail, or dividing ti of the fold, where the matter shows 

itself plainly through the cuticle. It is well to apply a poul- 
"' two Of three days bo a run-round of this kind, but it 
should then be omitted. All the loose cuticle should be care- 
fully pared off with a delicate pair of 5 anil the 
face will then be found moist, covered with an imperfect cu- 
ticle, and studded with minute ulcerations. If the old cuticle 
be suffered to remain, the soi< ,11 be very protracted; 
but, when removed, if it do not yield in a few days to the 
use of simple cerate, it may be cured by dusting it with dry 
carbonate of zinc. 

Whitlow* This is a much more formidable and terribly pain- 
ful disease of the lingers and toes. It sometimes occurs with- 
out obvious cause, and is apt to attack several digits in St* 
sion. It may be brought on by a bruise, by pricking with a 
needle, by biting or cutting the nails to the quick. The in- 
flammation may be seated either immediately beneath the 
thick, hard akin of the last joint, beneath the firm, tendinous fas- 
cia, or beneath the periosteum of the same part These three po- 
sitions constitute three varieties of whitlow; the severity of 
the symptoms, and the seriousness of the case, being propor- 

16 



3G2 NAILS GROWING INTO THE FLESH. 

tionate to the depth of the seat of the disease. The pain, in 
all the cases, is very great, and also the febrile reaction. The 
patient is generally deprived of all sleep until the suppuration 
has made some advance. In the deeper varieties, the pain is 
but slightly if at all assuaged by the suppuration until the mat- 
ter is evacuated. 

It is vain to attempt to cure a whitlow by resolution; and 
the local treatment should be such as to promote the formation 
of pus as quickly as possible, by means of warm bread and 
milk poultice, with which a little laudanum may be mixed by 
way of trying if it will give any relief to the pain, though, 
in most cases, it increases it. The general treatment should 
be active. Purges of Epsom salts, the lancet, strict low diet 
and repose, should be positively insisted upon. The on! 
medy which we have ever known to procur . uring the 

height of the attack, is tartar emetic or the antimonial wine, 
given in sufficient dose at bed time to produce decided nausea 
without vomiting. To effect this, give the patient twenty drops 
of antimonial wine every ten or fifteen minutes, till the re- 
quisite nausea is produced. 

The moment there is reason to believe that matter ha* 
formed, we relieve the patient at once by a very painful, but 
highly necessary proceeding, lo which no patient who knows 
the instantaneous relief which follows, will, for a moment, 
object. With a very sharp knife we divide, at one stroke, 
the whole inflammatory tumour completely from end to end, 
and to a depth equal to that of the disease. In the first vari- 
ety, we cut halfway to the bone; in the second, nearly down 
to it; and in the third, we cut firmly upon it. The pus is 
thus evacuated, and the case advances rapidly toward cure, 
under the use of the bread and milk poultice. From this 
moment there is rarely much pain, except when the hard 
edges of the thick cuticle press upon the swelled parts be- 
neath, which IS commonly the case in the first variety. 

The cuticle becomes detached from the parts beneath in 
mass, far and wide round the tumour, and should be cut away 
with a pair of scissors as fast as it is detached. The third va- 
riety is often very tedious; for the bone, or a part of it, fre- 
quently dies, and is long in being separated from the living 
periosteum. 

Affections similar to whitlow are occasionaliv seen on other 
joints of the lingers, in the palm ol the hand, and even on the 
fore-arm; but great care and correct anatomical knowledge 
are necessary in opening abscesses in these positions, and the 
cases should be left entirely to surgeons, unless there is the 
most urgent necessity for interfere 

Nails groivi fig into the flesh. This is a popular misnomer 



BILES. 363 

— for the deformity of the nail almost always originates in 
disease of the membrane near the commencement of the last 
joint of the digit, which secretes it. The pressure of the shoe 
or grasping with the hand then renders the edge of the nail a 
cause of irritation; but it is rather the soft parts which grow 
on to the nail, than the nail which grows into the soft parts. 

By prying up the edge of the nail, and placing cotton under 
it, so as to keep off the soft parts, and by cutting the middle 
of the nail thin, so as to make it flexible, we may give tempo- 
rary relief; but we know of no ellectual remedy except the 
application of lunar caustic to the whole sore surface, and re- 
peating the application once a week, if necessary, until the 
soft parts recede from the nail. The first application is gene- 
rally attended with considerable pain, but the succeeding ones, 
when required, give much less inconvenience. This remedy 
is generally successful. Poultices are employed for a couple 
of days after each application of caustic, and simple cerate 
during the remainder of the intervals. 

Biles. — These troublesome and painful, but by no means 
dangerous visiters, are generally, though not always, accom- 
panied by florid health, and may then be regarded as a proof 
of its excess. Those who are subject to a succession of them 
should avoid salt provisions, stimulants, and spices. If adults, 
they should purge themselves pretty freely with Epsom salts 
ev^vy other day for a week; if children, with sulphur and 
cremor tartar. All stimulant drinks and spices are injurious, 
and the appetite for meat should be sparingly indulged. 

A bile is an inflammation of the subcutaneous cellular tissue, 
(see Anatomy — skin,) leaving the skin in health, and is com- 
pletely limited in extent by the healthy capillaries around it, 
which completely agglutinate, or close, the surrounding cells. 
The inflammation of the centre of the tumour is almost always 
\ ere as to cause the mortification of the cellular tissue, 
which forms what is called the core of the bile, and the ab- 
scess cannot possibly recover till this core is discharged; hence 
the advantage of opening a bile freely with a lancet, which 
gives a free exit to the dead matter, when detached, instead 
of trusting to the slow process of nature in destroying the skin 
by ulceration, which terminates in the formation of one or 
more small orifices, giving a free escape to the pus, but often 
retaining the core for a long time. Indeed, we are often 
compelled to enlarge the natural orifice with the knife, before 
the dead matter can be removed. 

A gently stimulating salve, such as the basilicon ointment, 
or a mixture of mutton suet and resin, is the most common 
application to biles, in all stages; but, when at all convenient, 
the bread and milk poultice is preferable, until the matter is 



3o4 FURUNCLE — CARBUNCLE. 

evacuated, and for two days afterwards. The stimulating 
plaster then provokes less discharge than the poultice, and 
promotes the cure. 

Furuncle and Carbuncle. — Furuncle is an inflammatory 
tumour, resembling a very small bile in a state of intense ir- 
ritation, and exquisitely painful. It is not sealed beneath the 
true skin, but in its very substance, and consists in an inflam- 
mation of all the soft parts contained in one or more of the 
minute, tendinous or fibrous rings which form the outer sub- 
stance of the true skin, each of which gives passage to the 
delicate extremity of a nerve of sensation, and its accompany- 
ing blood vessels. The effect of the rigid rings acting upon 
such parts, when swelled by inflammation, must be obvious to 
all. The irritation is raised to the greatest possible height, 
and the swelling increases, until the soft parts, with the ner- 
vous pulp, are strangulated by the fibres, and mortify. Hence 
the intense pain and the febrile reaction which -attend the dis- 
ease. 

The best and least painful mode of treating this affectii 
to divide the tumour at once, with a sharp knife, and then to 
dress it with poultices; but. if the patient refuse to submit to 
this, it must, be treated like a common bile. 

Carbuncle differs from furuncle, in being a progressive in- 
flammation. Located in the same a, it affects i 
more of the tendinous rings; and the intensity of the irrita- 
tion continually eatiscs additional numbers to be added to 
those already involved, while a wide and spreading purple 
ring of hardening surrounds this central disease, and [ 
the way for its increase. The base of the tumour tfl 
hard and deep, involving the subcutaneous cello! 
down to the surfaec of the mttf f in- 
tense agony, an imperfect suppuration comes on, and, flowing 
into the few unclosed cells of the cellular I 
tumour peculiarly quaggy or doughy. In the mean time, the 
centre of the tumour mortifies, and numerous little ulcerations 
on the skin give partial exit to the ill-conditioned pus. The 
tendinous rings ol the skin partake in the mortification, be- 
cause their vascular support is entirely cut off by the destruc- 
tion of the soft parts around them; and the 
widely and deeply. During this process, unfortunately, the 
pain and irritation are not new parts around the 
circumference o( the dead skin are continually taking on the 
same kind of inflammation, and propagating the 

This complaint is peculiar to per>ens w! 
are weakened by disease, luxurious habits of living, or intem- 
perance. It is one of the most painful affections with which 
humanity is afflicted, and very frequently terminates fatally. 



CARBUNCLE. 305 

The proper general treatment varies with the condition of the 
patient. Sometimes the lancet will be applicable in persons 
not too far advanced in age, or broken down in health ; but 
the symptomatic fever is of a low type, threatening the 
brain and its membranes especially, and scarcely less power- 
fully the stomach. After the disease has made some progress, 
it is very generally necessary to support the strength of the pa- 
tient by wine whey, wine, bark, and other tonics and stimu- 
lants; but these should be employed with caution. Mustard 
plasters to the feet and wrists, and other means of counter-ir- 
ritation, when the brain is threatened, have been too much 
neglected. The spice plaster, mint lea, and alkaline medi- 
cines, such n» extra-soda-water, or doses of ten grains of super 
carbonate of soda, will often give relief to sickness of sto- 
mach, and the sweet spirits of nitre does good by promoting 
the tendency to the skin. If there be no acidity of stomach, 
or vomiting, cremor tartar water, sweetened, will be useful in 
allaying thirst, and promoting the flow of urine. 

As the first local application, a plain bread and milk poul- 
tice is best. When the suppuration has advanced, and orifices 
appear, Peruvian bark may be added; and when the mortifica- 
tion is at its height, the charcoal poultice is advisable. But 
the disease is terrible, and the local treatment should be vi- 
gorous. There are two methods of relief which will frequently 
save life, if the patient have the nerve to bear, and the prac- 
titioner courage to undertake them. The French method 
consists in dividing the tumour by the knife, in at least two, 
but if large, in live or six directions; this relieves in considera- 
ble degree, the tension anil strangulation which cause the 
violence and spreading of the inflammation and gangrene; but 
as the incisions cannot reach all the affected rings of the cutis, 
the relief, though great, is partial. There is no advantage in 
dividing more than the entire thickness of the true skin; and 
for this purposej the cuts should be about half an inch in t/epth. 

A much more philosophical, and really less painful method, 
though it has a terrible sound, is that of (lie late J)r. Physick. 
Me recommends the destruction of the entire thickness of the 
skin over a wide space in the centre o( the tumour with the 
:ihle caustic; which requires to be wet at the end of the 
stick, and to be robbed for some time over the surface. This 
destrovs all the strangulating and strangulated parts at once, 
and with them, the chief cause of pain and irritation. An an- 
thrax or carbuncle sometimes readies a diameter of six or 
eight inch 

When the sloughs separate, the surfaces of the fascia; or 
muscles beneath, will often be found completely denuded, the 
enormous ulcer which remains, will be usually in an irritable 



366 GANGRENOUS SORE MOUTH. 

or indolent condition, requiring appropriate treatment; and the 
scars are^sometimes a cause of much deformity and inconve- 
nience. The strength of the patient must be supported during 
recovery, by a generous diet and free air, as the discharges 
are long protracted and exhausting. 

Canker or Gangrenous Sore Mouth of Children. This 
terribly fatal affection is not uncommon in swamp? di>t 
and occasionally appears epidemically on a much wider sphere. 
Its chief victims are children from the ages ofeig nths 

to ten years, and it is confined almost exclush elf t » th 
constitutions have been shocked or debilit | .receding 

disease; especially by intermittent or scarl* I 

The disease appears, at first, as a redness and inflammation 
along the edges of the gums, — commonly on the incisor teeth 
of the lower jaw; and it runs pretty rapidly from tooth to 
tooth. A slight discharge of fetid pus may soon be per- 
ceived along the inflamed line, and an evident ulceration soon 
succeeds. 

The inflammation speedily attacks the periosteum of the 
sockets of the teeth, loosening first one and then another, and 
extending also to the periosteum of the jaw. The discharge 
becomes daily more profuse and fetid, and, in a few d 
the gums generally begin lo swell. 

At thi> lie of simple debility with which the 

patient had been previously all- d for a febrile 

condition, of a low or sinking character; the tongue is thickly 
furred in man] Jims anil throat are loaded with 

foul and often adhesive matter. 

The child is now unable to pursue his sports or studies, 
though, until this period, the c apt to escape 

tion, unless the mortality prevalent around them baa 
the attention of the friends. This < ; for 

the diseSM advances from this point with fearful rapidity. 
One or both cheek! . and the inflammation runs 

high. Spots of mortification appear, usually, on the gums, 
sometimes on the inside of the cheek, or v y in the 

throat. The gang treads in every direction without 

check, — involving, in a few daj rtion of the gums, 

or perhaps the whole thickness of the cheek. It pa] 
spect to the bone of the j ig not only the teeth 

and their sockets, but, where life endui\ - 
portion of the bone. 

The child is sickened and diarrhoea follows, from the quan- 
tity of fetid discharge unavoidably swallowed: and exhaustion 
and death soon close the scene. 

This disease was found most terribly mortal from the time 
at which it was first described by Mr. Pearson, until the | 



GANGRENOUS SORE MOUTH. 367 

ers of sulphate of copper, as a remedy, were developed by 
Dr. B. H. Coates, at the Children's Asylum at Philadelphia. 
It is now manageable by severe measures in a large majority 
of cases; but after the appearance of mortification, it will prove 
almost certainly fatal, unless treated by fearless and expe- 
rienced practitioners. 

The support of the patient's strength, and the general treat- 
ment, may be regulated according to the directions laid down 
for excessive suppurations; the mineral acids being highly 
serviceable as tonics. In addition to this, it is proper to give 
about half an ounce of sweet oil, and two grains of calomel, 
daily, when the bowels are disordered by the foul discharges. 
But the general treatment is of no avail whatever, if the local 
remedies be not most faithfully applied. The directions for 
the local treatment are these: — 

The moment that the disease is recognised, every tooth 
must be carefully examined, and if found in the slightest de- 
gree loose, with the gum in a suspicious condition, it must be 
immediately extracted without wasting a thought on the mere 
loss of appearance. This done, a solution of the sulphate of 
copper, perfectly saturated, (for a weaker solution is of little 
value) must be provided. A small slender stick, or piece of 
whalebone, armed at its extremity with a soft, piece of rag, 
must be dipped into the solution; and, after being thoroughly 
soaked, the rag must be rubbed freely and firmly over every 
part of the ulcerated surface, being made to penetrate to the 
bottom of the socket of every extracted tooth, and between 
the gum and the bone of all those which remain within the 
range of the disease. This will occasion some pain, and a 
little bleeding; but the question is one of life or death, and 
these inconveniences are trilling. Care must be used to 
rinse the mouth, after the operation, with sage tea or some 
other mild gargle, and if possible, to prevent the child from 
swallowing any portion of the solution, which is a powerful 
and somewhat dangerous emetic. 

The application should be repeated every day until the pro- 
gress of the disease is arrested, and the discharges have as- 
sumed a more natural appearance. The success of the treat- 
ment depends mainly on the care with which the solution is 
made to touch every point of the diseased surface; and it ap- 
pears to be chiefly on account of the necessity of this contact, 
that after mortification occurs, the case is generally incurable. 
The dead surface then prevents the wash from reaching the 
diseased parts beneath, unless these are soaked through with 
the solution, or the sloughs are pared away or divided by 
means of the knife: — alternatives which can be employed only 
by surgeons. 



368 BURNS AND SCALDS. 

The skilful practitioner does not despair of even these des- 
perate cases, which are inevitably fatal in popular hands; for 
cures have occurred after the mortification of the entire thick- 
ness of the cheek. The author himself once had occasion, 
after the partial recovery of such a case, to remove the whole 
of the upper jaw bones, except the portions supporting the 
sockets of the two last molar teeth on the ri^ht side, and the 
last molar, on the left. Not only the palatine, but even the 
orbital processes came away, yet the patient recovered! 

Fresh air and cleanliness are as important in this disease as 
in any febrile complaint; and a change of residence should be 
made, if practicable, when the location where it occurs is cold 
or damp. 

Bum* and Scalds. 1 laving already spoken of the effect and 
general treatment of very extensive burns or hen pro- 

ductive of colhpv | only remain! for us to j 

some succinct directions for the local treatment of these inju- 
ries. 

There is littl a burn and a scald. 

that i 

moisture, while in the former, wh< they 

are often hardened or i - by the action of the heat. 

In every burn or scrdd unattended by collapse, the I 

i most powerful stimulant, giog the 

blood in the distended capillaries to a hig 

At all event-. :e to the air certaink it in- 

erease of the pain, and heightens m teviolen 

inflammation. To plunge the part into, or to bathe it freely 
with colli water, is almost an instinctive, and an apparently ra- 
tional impulse; but it is foil iically, that water is also a 
stimulant to the surface, under such eireir 

'ban the air. The co! tefal, but the inju- 

rious chemical or physiological action of the accent by m< 
of which it is applied, far on' A 

burn, should never be touched with < > bile un- 

protected. H ig the i: rt with | ight 

pellicle of unctuous matter, not in a ra; . much of 

evil influence o( the air, and that of the v. | and 

the latter may then be employe! as a re' - lera- 

ble benefit in certain eases. We shall speak hereetefir of 
unexplained effect o\' cotton, — an article often cm; 
not on empirical, at least on hypothetical principles, but one 
of which the astonishing good ion- 

able. These remarks premised, the n -land 

the reasOnab our practical directions. 

In very small burns, it is found that the a 
potato furnish the most decidedly dclig 



BURNS AND SCALDS. 369 

lions; but, unless the part be previously touched with good 
sweet oil, fresh, unsalted lard or butter, goose grease — or, if 
nothing better be accessible, pure spermaceti oil, the effects of 
the potato will be very transient, and the intervals between 
the renewals of the cold scrapings, (which must be very fre- 
quent,) extremely painful. 

If no potato be at hand, let the part be oiled, and then held 
for a long time in cold water. Treated in this way, the seve- 
rity of the pain will subside in from twenty minutes to two 
or three hours. After which, if the burn be deep, cold bread 
and milk poultices, well covered with good oil, form the best 
dressing. 

In all large burns or scalds, unattended with collapse, the 
first question is — Has the cuticle been extensively broken? 
If not, then let the part be instantly enveloped in carded cot- 
ton, which should bo kept at hand in every family, in case of 
accident. If there be a delay of more than twenty minutes 
in this application, it will be of little service; and if delayed 
for an hour, it will prove decidedly injurious. 

When the article cannot be procured in time, let the parts 
be well oiled; and if not too ex inconvenient- 

ly situated for immersion, the case may then be treated with 
the cold water: but we hi Ml any benefit result 

from simply bathing the parts with wa1 

When the situation or extent of the burn precludes the use 
of this remedy, it should be dressed with the ointment o( 
lime water in Dtl, in the manner which II pre- 

sently describe. 

In burns and scalds with extensive rupture of the cuticle, 
we cannot with any propriety apply the cotton in the first in- 
stance; but after a complete oiling of the part, if the time 
d after the accident be not too considerable, it may be 
employed to much advantage. The benefit derived from the 
application of cotton appears to be limited to about twenty- 
lour hours: it may then be d carefully* and a dressing 
applied, consisting of patent lint, linen, or muslin, well coated 
with lime water and sweet oil. These ingredients may be 
mixed in equal parts, or with an excess of the former, by 
shaking them together in a wide-mouthed vial or decanter. 
They form a kind of white paste, very soft, and extremely 
agreeable in its effects. 

This dressing should be renewed two, three, or four times 

a day, until a new cuticle begins to form, or until suppuration 

is established over the surface. When the latter termination 

takes place, the case is to be treated as a simple ulcer. (See 

18.) 

If the burn be deep and so as to harden and render 

17 



370 WHITE SWELLING. 

crisp any part of the skin, this must mortify and slouch awny. 
In such cases, it is best to omit the ointment in about forty- 
eight hours, and then, to use poultices until the sloughs - 
rate: after which the case may be treated as an ulcer. 

Burns are extremely apt to give rise to redundant granula- 
tion, or proud flesh; and when this cannot be held in check, 
by the means already laid down for the purpose, (p. 341) the 
tar ointment will be found a valuable remedy. The Kentish 
ointment should never he employed in burns unattended with 
collapse; but when the ulcers which remain become dec! 
ly indolent, — which rarely happens, — bathing the parts wiih 
brandy is sometimes highly serviceable. 

The reaction, and symptomatic fever produced by burns or 
scalds of moderate . should be treated like the same af- 

fections in other inflammations, and \ 

ha U Sting suppurations which are very apt to occur, render 
highly ii' the precautions laid down- under the appro- 

priate head. (p. 337.) 

The cicatrices of b : I disposition 

to contract and produce deforn iich cannot be wholly 

prevented; bat great care should be employed in placing the 
injured parts in the n :al and useful p id in 

•:ing the: Where 

surgeons cannot be obtained, something may be done in this 
. even by the intelligent who are not of the profession. 
For the treatment of burns and •roductivc of coll 

we refer to our remarks contained under the head of Inflam- 
matton* coupled with coUqpt . I ■;.) 

White Swelling. — The term white swelling implies the 
enlargement of a joint without dislocation. In 
inclu< tty wide 

which we shall briefly consider under Ulifl 
white swelling of the knee joint; the most I . perhaps, 

and the most alarming of all the affections of joints whi 
sume ■ chronic cl m most fi con- 

sists in an inflammation of the synovial membrane; the 
consequences oi which are in and altt - vtion 

from its internal surface, effusion of lymph into the jo 
times a change of structure in the membra: Ouch 

it is converted into a grist! UlStOD 

of lymph into the common cellular membrane. The carti- 
lage, and even the bones, may be eonsecuti 
sometimes the inflammation, commencing in I 
tends itself from them to the softer pel 

White swelling is often connected with a scrofulous 
the system. In this case, it is much more I - 
cult to cure, and the cancellated structure of the bone is the 



HIP-JOINT DISEASE. 371 

primary seat of the affection. This form appears most fre- 
quently in children, while that which commences in the sy- 
novial membrane rarely occurs in young subjects. When in- 
flammation of the synovial membrane subsides spontaneously, 
the fluid is absorbed. In some instances, the joint regains its 
figure and power of motion; but in others, it remains perma- 
nently stiffened, and swollen; leaving the patient liable to a 
recurrence of the inflammatory action on exposure to cold, 
and other local causes. It should not be forgotten that white 
swelling, though it arise in many of its forms from constitu- 
tional causes, may be induced by accident in those who are- 
predisposed to it; so that, if after exposure to cold, a contu- 
sion or painful swelling occur in the knee joint, and the 
swelling long outlast the pain, the case must be immediately 
submitted to the inspection of a surgeon. 

Of the treatment of white swelling we shall say but little; 
as it require! consummate skill and long experience. One 
remark, however, will not be misplaced. In the primary 
stage of all affections of the joints which threaten to become 
chronic, absolute rest is of the utmost importance. Not only 
should the patient be restrained from using the hip joint at 
all, but the horizontal position and perfect quietude must be 
resolutely maintained. The proper general treatment will be 
fully noticed under the head of scrofula, when the local dis- 
18 connected with a scrofulous habit. 

Hip-joint Disease. This disease bears considerable resem- 
blance 10 its nature to white .swelling; and, like it, is some- 
limes, but not always, connected with a scrofulous constitu- 
tion. The complaint is moat frequently seen in children un- 
der the age of fourteen; but no sex or condition is exempt 
from its attacks: and the number of adults and even of old men 
affected with it is considerable. 

The approach of hip disease is much more insidious than 
that of white swelling, and its primary symptoms are often 
overlooked or mistaken. The first circumstance to be noticed 
light limping. The child, for example, in ascending a 
ilight of stairs, will advance the sound leg and draw the other 
up to it, without attempting to put this one forward in its turn. 
In walking on a level, the affected limb is either dragged 
along upon the floor, or the weight is thrown for the moment 
upon the toes only. In the last case there is an appearance 
of shortening; in the first, of lengthening of the limb. Both 
appearances, however, are deceptive. No variation in the 
length of the limb occurs until a late stage of the complaint, 
when extensive changes have taken place within the cavity of 
the joint. The symptom now alluded to arises from the effort 
made to avoid calling into play the muscles of the affected 



'j~fZ IIIP-JOINT DISEASE. 

limb, qs is done in natural walking. When these appearances 
are noticed, immediate attention must be directed to the sus- 
pected hip. If it be really the seat of the disease, the usual 
.depression or dimple between the hip and the nates will be 
found effaced, and its place supplied by an observable pro- 
tuberance in most commenci:._ 

The seat of the pain at the t> _ g of the disease, is un- 

certain, and of itself offers no suiTicient evidence of the true 
state of things. Sometimes it shoos down from the hip to 
the knee; sometimes it is referred exclusively to the latter 
part; sometimes to the foot; and sometimes it shifts from 
place to place, without remaining long fixed in any one spot. 
Sooner or later, however, and often from the beginning, a 
fixed pain is experienced in the part above referred to, imme- 
diately behind the hip itself. From the first, moreover, if we 
make • either before or behind the hip, we produce 

an Ul >;ition, sometimes amounting to acute pain. 

othf : - the eoai 'here 

s often, . ly period, an emaciation of the af- 

nd the correspon 

toms 
of th 
to ro 

: ima- 
rv Btage of ihe du 
IDg will accompli>h more than I 
lame and painful issi nth. 

The p: make pro- 

cess fori i 

rj mp- 
The 

This i 

fatal termination. l r 

dence of I 

articular 

located 0] 

shortened : and a >nsequei 

the union beU 

: the 
bone acquires a degree of mobility in it 

Itappe i 1. That 

commences with f the 

socket being generally 
the head of the thigh bone. "J. The ale 

hones, which become- . An abscess forms in the 

joint, which il mem 1 



corxs. 373 

and the capsular ligament, generallv bursting on the thigh. 4. 
In the progress of the disease, all the soft parts about the joint 
become involved, forming a common confused mass. A distinc- 
tion, likewise stated on good authority, is, that in cases of a 
scrofulous character, the primary seat of disease is the bone 
itself. 

It is of the utmost importance, that the domestic observer 
in this disease, should seek the best surgical aid without de- 
lay; contenting himself, until it is obtained, by enjoining the 
most absolute rest in the horizontal position. 



SECTION VI. 

Corns, JVarts, and Moles. 

We have deemed it unnecessary to dwell upon the charac- 
ter or treatment of particular tumours and excrescences re- 
sulting from hyper-nutrition, morbid nutrition, or the transfor- 
mation of complaints of these classes admit of 

sufficient delay to allow the patient to procure medical advice, 

and but t< can properly form the subject of domestic 

treatment under any circuit • p. 151,) but it would 

be srn entirely unnoticed the thre ■ forms of hyper- 

nutrition which stand ai the head efthii 

Cams. It has been stated, in the anatomical chapter of 

this work, that the nails, fa productions of the cu- 

: or. at 1 able that horny membrane. 1 tarns are 

nothing else than unusual growths of the cuticle, caused by 
habitual p| upon prominent portions of the body. They 

joints of the toes, where they are 
of tight booti or shoes; but they do not 
diner from th< es not unfrequently noticed on the in- 

step, heel, hip, elbow, or knee, when either of these parts is 
subjected to long-continued pressure. Their com seems 

iate between that ol ordinary cuticle and that 
of the nails: though, after a time, it becomes analogous to the 

latti 

These excrescences arc themselves incapable of inflamma- 
tion; but they often occasion great suffering when they inflame 
the p ind them by their pressure. They sometime 

come surrounded by a little abscess, and are then cast off or 
cured. 

The proper treatment of con: simple, — and, if faith- 

fully attended to, — almost certain! 1 -iul. Let the part 

be well soaked in warm water; then with a sharp penknife, 



374 eoiixs. 

pare away the summit of the excrescence until it is level with 

the sound skin or a little depressed below it. In the next j 

provide some buckskin well coated with good adbesi 

tor. Take a circular piece of this, about thi 

in diameter as the corn, and cut a hole in its centre, a little 

larger than the base of the corn. The ; 

around the excrescence; which o 

so that nothing can pi i*. Tn 

moved, the di a disappears, li 

rapidly for a time, let it he frequently retric : the 

plaster reappli 

When corns occur betwt en tl ften imp 

surround I hem, and it i< then 

of the buck-skin between the poioi 
them permanently apart;— bat, let it b 
that the appli< 
tends to inert 

Under the foregoing ly and ju 

applied, we behev< that • 

the junction 

skin i- perpetually fold i un- 

common t<> ol 

with a thin and red ; 

no slight resemblam 

rOUghly soaked, and ihen eut I 

affection has been CSJI< .." but a 

iated or i 
in its natnn . The thi 
stilts from the simple imbil 

andthe thin, red surfa< in. tram: 

moisture, and the 
the n 
fetid • 

ful : it i> sometime 
the fold of the 10 

In the treatment 

as in as in tine corns; but inert 

here, in applj 

sure is not among the The mas1 

tuaJ mode of euro La to keep tl wash tht 

thoroughly with Castile soap ami water, twi i then 

to dust the part well with the powder 
and io place a piece of soft patent lint on thedjscsw - 
Cleanliness, and some dry! material occasion- 

ally applied are necessary, permanently, 

renee of the disease; — an accident alwaj • from 

the constancy o( the cause. 



WARTS AND MOLES. 375 

Warts. These are horny productions rooted in the true 
skin, and not in the cuticle. They are at first enclosed in a 
distinct sac, and it is the front part only which is afterwards 
removed; so that the excrescence seems to be always seated 
in a cup of membrane by which it is secreted. This mem- 
brane must be destroyed, or its functional action changed, be- 
fore the disease can be cured. When seated, as it usually is, 
on the palm of the hand, a wart often appears closely con- 
nected with the fascia or tendinous sheaths of these parts, with 
which the true skin lies in close contact. A vascular produc- 
tion of the membrane forming the cup sometimes penetrates 
far into the body of the wart, and bleeding may then be pro- 
duced by very >lij;ht injuries of the part. On the extremity 
of the back of a fil wart will sometimes adhere firmly 

i to the periosteum. 

It is dangerous to tamper with excrescences of this charac- 
ipecially when seated on the face; as an injury accident- 
ally indicted is apt to produce troublesome ulceration; and, on 
the face, even cancer may be engendered thereby. 

Fumigation with hot water, or with hot infusions of aro- 
matic plants, placed in a metallic vessel, and the steamcol- 
lectcd by an inverted funnel, will sometimes remove warts. 
The Steam from a decoction of the root of the narrow-leaved 
dock, has the reputation of superior virtues, we know not 
on what ground. The juice of the Garden eelendine, and 
vinegar used as i wash, occasionally succeed. 

Lunar causti • jiiently used to produce an absorption 

of tin - . but it is a rather dangerous remedy. 

If the dread of the knife induce the patient to refuse the best 
mode of operating, which conaU lovingthe wart and its 

membranous base by cutting, the entire destruction of these 
parts by mes caustic, which acts deeply and 

effectively i may be admissible. 

Unless there is in the location of the wart, some good rea- 
son why it should be removed, it is wisest to leave the case to 
nature; ami spontaneous cures will not unfrequently occur. 

)le*. These are small tumours, often adhering by a narrow- 
neck, and composed of the same substance with the true skin, 
from which they arc derived. These productions are seldom 
a source of material uneasiness, but they sometimes disfigure 
the person, and at other-, give 1 "ise to inconvenience in sitting, 
or lying in certain attitudes. The mole should then be re- 
moved, either by a single clip with a pair of sharp scissors 
carried quite down to the base of the production, or, if the 
connections be wide, by a circular cut with the scalpel or bis- 
toury. The latter operation is the exclusive province of the- 
surgeon, but the former may be safely performed by a friend. 



376 SCROFULA. 

If there be trouble in stopping the bleeding, or if a very small 
portion of the diseased substance have escaped the scissors, it 
is well to touch the cut lightly with lunar caustic. Some per- 
sons, through dread of cutting instruments, prefer the ligature 
for removing moles; but this method seldom accomplishes the 
purpose so completely, and is decidedly more painful than 
that for which it is substituted. 



SECTION VII. 

Constitutional dia< 

Scrofula. — Which U called also the K . tfl a constitu- 

tional disease, manifesting itself principally by 
of the absorbent glands, which terminate in imj uppu- 

ration. The d . but 

not coiil;: 

known means, from an I individual, 

subject- are children from tin 
it has been i 
tion which enables it 
obvioi 

tioned a florid countei 

fulness of the upper lip, extt I thin the blue- 

eyes, light hall auch 

depended on; for some of 
country, occur in 

All the cir id to produ< - 

predisposing i . an unheahn 

mosphere, imj 

i rded in this light Where th 
disease will of) ir independently 

tary influence ; u r . and all 

iniliu 

will generally escape. For the production of scrofula, t!. 
fore, there seem to be requisil 
tendency, and secondly, the million i 
agent, to call it into action. 

The following description will convey 
of the disease, h usually commences wkh a so 
one of the lymphatic glandi nerallv. in children, about 

the ear or net k. The covering OJ 
thickened, and the whole mass 
which may be compared to that of leatlu inges 



SCROFULA. 377 

into a character of elasticity, and even of fluctuation, while a 
firm circumscribed margin can be felt around the base of the 
tumour. The skin is slightly red. If an incision be made at 
this time, no matter, or a very little only, will be evacuated; 
but the wound remains open, exhibiting a slough or core 
within, between which and the skin a probe can be passed 
for a considerable distance. At a later period, however, the 
tumour lo ! astic character, becomes soft and flaccid, 

and iluctuates freely: the skin assumes a light purple colour, 
and small veins may be traced on its surface. It soon grows 
thinner and darker, bursts, and di I a thin fluid like 

mixed with some portion of curd-like substance. The 
aperture enlarges as the tumour subsides, and the sore 
sumes the character of ao ulcer, with a smooth, hard, tumid 
margin, of a purple colour. Its surface is light red; and the 
ire pale and unhealthy. The discharge is thin, 
and mixed iv. with curdy flakes. A \ hen the ulcer has 

continued for some time, it begins slowly to heal, the discharge 
,v diminishing and becoming thicker. An elevated scab, 
of a dirty white or yellowish colour, is next formed. This 
continuca for some time: then falls oil", and leaves the place 
covered with a purple scar. Some, scrofulous 

after bursting, sinus, the mouth of which assumo the 

appearance of a scrofulot while th of the 

sinus con tin i 

The parts which are most frequently affected with scrofula, 

10 the lymphatic .md perhaps the skin, are the 

■poogy extremities of the bones and the joints. In scrofulous 

SUOJe :!ar to those in the glands appear in va- 

parts of the body. Finally, the glands of the mesentery 

are often found, in scrofulous subjects, to be universally en- 

1 and diseased; a circuit. which, more than any 

olher, determines the claim of the - j a constitutional 

character. 

In this country, the prevalence of scrofula is, for the most 
part, confined to the southern states, where it is very common 
among the blacks, and to a considerable extent among the 
emigrants from Europe. Cases of it, often of severe charac- 
ter, are always to be found among the neglected children of 
the poorer classes in all the principal cities. 

As scrofula illy a disease of debility, and the pre- 

disposition to it is rendered active by all external causes 
which go to impair the constitution; so both in its prevention 
and its cure, those means are to he adopted, which have an 
opposite tendency. If possible, the air of the city should be 
exchanged for that of the country; that of swampy districts* 
for drier situations; unwholesome food, for that of better qua- 

L8 



378 CANCER, 

lity, and the clothing, state of the skin, and regularity of 
the bowels should be most carefully attended to. Salt water 
bathing has been recommended as a tonic, peculiarly suited to 
these cases. In employing salt water, however, we must 
carefully attend to the power of the system to react under the 
chill. As respects internal remedies, the tonic bitters have 
sometimes had the reputation of benefiting the complaint; at 
others, mild alteratives, as the sarsaparilla; and again, alkaline 
medicine; but at present, nothing seems to be so much relied 
on as the iodine, the virtues of which in reducing glandular 
tumours under certain circumstances are undeniable. 

In tumours which have not advanced to suppuration, and 
which are external, frictions with an ointment of iodine are 
used locally; but in internal tumours and scrofulous ulcera- 
tions, some of the fluid preparations, internally exhibited, are 
generally preferred. 

Of Cancer. Cancer generally commences in a hard, well 
defined, heavy, and sometimes knotty tumour, beginning in the 
secreting glands, but often propagated to other parts, and ter- 
minating in an ulcer with thick margins and a fetid discharge. 

A predisposition to cancer is unquestionably hereditary ; but 
with what peculiarities of structure this predisposition is con- 
nected, or by what external signs it may be known, is mere 
matter of conjecture. 

Cancer is not contagious; and the experiment of communi- 
cating the disease by inoculation has always failed. Jt is most 
frequent in women; and the object of its primary atta< 
most generally the female breast. Unmarried women after 
the age of forty are most liable to cancer ; and, next to these, 
mothers who have not suckled. Next in the order of frequen- 
cy, come married women who have reached the period 01 
above referred to. When cancer occurs in men, it i- chiefly 
in the lips or on the face, where it is commonly caused by the 
irritation of a peculiar kind of wart. 

The accidental or occasional causes which develope the con- 
stitutional tendency to cancer, are numerous. Among them 
may be mentioned various kinds of external injury: pre-€J 
ing tumours, accidentally irritated ; severe eruptive disc, 
and the time of life. 

Cancer in the breast usually commences with a small indo- 
lent tumour, which for some weeks, months, or even years, at- 
tracts little attention. After a longer or shorter period this 
tumour is affected with itching, which is soon exchanged for a 
pricking or lancinating pain, often very intense, and generally 
shooting in the direction of neighbouring glands. A 
burning, and a livid discoloration of the skin appear still later 
in the case. When these symptoms are united, i: row 



CANCER. 379 

character of the disease may be considered as manifest, but 
previously it is usually termed scirrhus. Hardened bands are 
now formed in the integuments, which become puckered ; and 
the nipple, gradually retracted, sometimes wholly disappears. 
At this period the tumour approaches the skin, and feels knotty 
to the finger, while varicose veins usually begin to show them- 
selves on its surface. Sooner or later the integuments give 
way in places, and a small quantity of fluid mixed with blood 
is discharged. The ulcer rapidly enlarges till a considerable 
cavity is exposed, from which issues a most offensive discharge. 
At this period, granulations sometimes form; but they are loose, 
soft, and unhealthy, and seldom extend over the whole surface 
of the sore. Whatever appearances of a tendency to heal the 
ulcer may assume from time to time, no real progress is made ; 
its ravages extend until the whole gland is involved, and the 
weight, pain, and fcetor of the tumour render life a burden. 
Even under these appalling circumstances, however, existence 
is sometimes wonderfully protracted ; and during years of suf- 
fering, the vital powers continue their bootless struggle. 

When cancer attacks the uterus, it is known by lancinating 
pains in this organ shooting through the region of the pelvis ; 
and there is, after a time, a mixed, unhealthy discharge, having 
the peculiar odour which belongs to the disease. Occurring 
in the stomach, cancer is obscure, and during life is seldom 
more than suspected. There are acute and burning pain at 
the pit of the stomach, tenderness on pressure, nausea and re- 
jection of food; but these symptoms do not enable us certainly 
to discriminate between this disease and many others. 

Cancer of the lip usually commences with a slight fissure, 
or crack, which being irritated by injudicious applications, 
takes on a malignant Yorm. On the tongue, the disease first 
manifests itself in a small wart near the tip. Both this and 
the last form are easily removed by operation, and they rarely 
return. On the cheek and nose cancer is usually preceded 
by a wart, which, when not subjected to irritation, may remain 
harmless for life. 

Cancer of the breast, in its early stage, admits of relief from 
leeching, lead water washes, and the constant application of 
sheet lead to the surface of the tumour. At a later period, 
when the ulcerative form is fully developed, the application of 
arsenic has been much resorted to ; and this substance forms 
the basis of most of the cancer plasters in common use. It is 
a violent and dangerous caustic. Among internal remedies, 
the most lauded, perhaps, for a time, was the hemlock, (conium 
maculatum, cicuta) but it is found that though this remedy may 
operate for a few days like a charm, the benefit then sud- 
denly ceases, and an increased dose is required, of which the 



380 VENEREAL DISEASES. 

effects prove equally transient. Externally, a poultice of 
cicuta sometimes gives great temporary relief. In fine, it is 
generally conceded, that there is no cure for cancer, and that 
the sooner the diseased gland is removed, after its true condi- 
tion has been satisfactorily ascertained, the better. If 
operation be delayed, the disease almost invariably extent 
self to the axillary or other neighbouring glands, which are 
removed with difficulty, and if suffered to remain, will cer- 
tainly reproduce the disease. 

Cancers of the skin rarely return after operations, but those 
of other parts are extremely prone to do so; partly, bc< 
surgeons arc too frequently indisposed to extend their O] 
tions far enough ; partly, because the operations are . 
deferred too long; but still more frequently because tb 
instead of being merely local, is the result of a constitutional 
peculiarity. 

Venerea . — V\"omen of uncleanly babi: r to* 

have the live organs constant!; 

acute intlammati' led with more or less acrid 

rge; and in t] ::i to be capable of communi- 

cating to I : >rms 

of inflammato: 
and appears i 

inflamed red hue 

opens at a point. I 

portion of limpid virus. The chancre show 
puce. • of the urethra. It 

on the third or fourth day after coition, more commo: 
ever, a A later; and someti 

Instead of chancrei 
which may extend over col :cc. 

The second eflfi - coition is a tumour in the 

groin, generally commencing in one or I the lymp 

glands, enlar . 

to Mippi;: 

reached a coi ainal tu- 

mours remain 

considerable period. r ap- 

pears indepen nerally < 

dered as a coi 

tion of its peculiar secretion. the inflamn. 

often extends to the spermatic cord, causing 
larged and tender, and likewise to the t< which be< 

swollen. 

The third affection which oral 

cause already mentioned, is an inflammation of the 
surface of the urethra, at first recognised by a burni 



VENEREAL DISEASES. 381 

tion in passing the urine, and soon afterward by a discharge of 
mucus, and then of yellow coloured pus from (he passage. 
The scalding usually subsides in a few days, and the discharge 
may be diminished almost to nothing, under proper manage- 
ment. This change may occur, even without treatment, in 
from eight to twenty days; but the discharge frequently changes 
its consistence, becoming thin, chronic, and continuing, with 
ional intermissions, for months, and even years. This dis- 
ease i -able of producing a sympathetic affection of the 
testicles, like that mentioned afa upervening on bubo. 

These forms of disease may occur separately or together; 
and, as we id, the IV often in a condition to com- 

municate one or all, according to the condition of the recipient, 
and oilier circumstances have led some physicians to 
the conclusion that the cause which produces these diifercnt 
affections is one and the same, and that the effect is merely 
modified by peculiarities of constitution in the individual af- 
fected. Perhaps the more genera] opinion however is, that 
they arc not produced by a single poison; that the first two con- 
stitute one disease termed syphilis, of which the bubo and 
chancre are alike symptoms, while the third — gonorrhea — is a 
distinct affection emanating from its own peculiar poison, and 
elf only. 

Th i iv symptoms of syphilis, which constitute a most 

important feature of til nimence with soreness and 

ul< erative inflammation of the tonsils, uvula, palate and tongue; 
by which the yoii e i^ rendered hoarse, and the swallowing 
structed. The ul< tut the throat arc foul and rough, 

having an excavated centre covered with a white or gray 
slough, and surrounded with a hard, elevated, and deeply red 
;a. The skin is attacked with an eruption, not of strictly 
uniform character, but illy attended with copper co- 

loured spots, which at first fall in svuv( or scales, and after- 
wards form sc a l)^; these often degenerate into ulcers, which 
prove foul, offensive and obstinate. With the advance of the 
disease, pains are felt shooting through the limbs, and the in- 
vesting membrane of the bones becomes inflamed and swelled, 
forming what arc termed nodes, especially observable where 
the bones approach near the skin. The small hones of the pa- 
late and nostrils next begin to participate in the disease, and 
are gradually eroded; the voice becomes nasal and imperfect, 
and the form of the nose is lost. These secondary symptoms 
often supervene upon syphilis, but never follow simple gonor- 
rhoea, unless improperly treated by mercury. 

The old or Hunterian school, which taught the identity of 
all the forms of venereal disease, taught also that an actual 
specific virus was present, in the matter of venereal sores, and 



382 VENEREAL DISEASES. 

of gonorrheal discharge, which, being absorbed into the 
tern, give rise to the secondary symptoms; — that this virus 
could never be entirely eradicated by natural effort; — but 
-that mercury possesses a peculiar affinity for the venereal 
virus, combines with it, and renders it inert, which no other 
known substance is capable of doing. These opinions are 
now almost universally discredited. In fact, experience has 
shown, that secondary symptoms, instead of being peculiar to 
cases left to nature, supervene quite as frequently on those 
cases in which mercury has been largely employed; and it is 
generally conceded that the venereal disease, in all its forms, 
is capable of spontaneous cure. Nay, so great has been the 
change of opinion on these subjects, that some of the 
forms in which the secondary disease shows itself, the affec- 
tions of the bones for example, are, by many, believed to be 
themselves of mercurial origin, and to be developed by the 
treatment, rather than the disease. 

One of the most interesting, and obscure questions relative 
to this dia that of i! which regulate its pro; 

tion. It is the general opinion, that the actual contact of the 
matter of chancre, or of gonon quired to produce the 

KMind individual. 

It would appear, therefore, that a husband can communi- 
cate cither disease to his wife, only so long as the local symp- 
toms continue; and that an individual, while still sufl 
under constitutional symptoms supposed to be syphilitic in 
character, may be justified in marrying. But though this 
proposition may be strictly true a> mmunica- 

tion of these Bpecific - in their primary form, < 

riencc abundantly shows, that, from a system affected with 
secondary symptoms. mptoms, or other 

them may be communicai seems to be proved be; 

a doubt, that a mother I with the secondary symptoms 

only, may communicate them to her infant; that an inf.i 
affected may nda- 

ry symptoms, either consequent to prii r re- 

ceived from a diseased infant, may again communicate them 
to another infant; — the peculiar organs in which the primary 
disease shows' itself, remaining mean while unaffected; — 
that a father who labours under secondary symptoms, though 
he may not communicate them to his ici/c 
ever be blessed with a healthy child. 

Treatment. Opinions are still divided on the question, 
whether mercury is to be regarded as in an] Rtfic 

in syphilis. The idea, that the disease is incurable without 
mercury is now abandoned ; but this retm H consi- 

dered as one of great value, and, in the majority of cases, will 



VENEREAL DISEASES. 383 

probably continue to be resorted to. In chancre, a slight mer- 
curial course will cause the ulcer to assume a healthy charac- 
ter, and to granulate kindly; and in bubo it will often prevent 
the tumour from suppurating. Whether the remedy acts 
specifically or by counter-irritation is unimportant. It is ge- 
nerally conceded that cures effected by this method are more 
rapid than when no mercury is employed. In the latter case, 
it is necessary to subject the patient to severe restrictions in 
regard to diet, rest, fee., which are attended with far more 
inconvenience than results from the employment of mercu- 
rials when judiciously conducted. Salivation should never 
be intentionally produced; for a slight swelling of the gums, 
and factor of the breath, are sufficient indications that the spe- 
cific action has taken place; and this action may be cautiously 
maintained until there Ifl observed a decided tendency to 
rapid improvement, which usually happens in from two to 
six days; the effecta being more rapid on chancre than on 
bubo. Longer than this we would never continue the action 
of mercury. In the local treatment of chancre it often happens 
that nothing is requisite but to keep the ulcer clean, either by 
simple lotions, or by solutions of the astringent salts; as alum, 
sugar of lead, white vitriol, &c. In addition to this, some 
ointment must be employed, the choice of which may be regu- 
lated by the principles laid down in the sub-section on ulcers, 
(p. 33S.) The ointment, or simple powder of the red precipi- 
tate of mercury, is a favourite application, when the ulcer is 
covered with an adherent gray matter, and the carrot poul- 
tice is generally employed in the phagedenic or burrowing 
form of the disease; but here we much prefer the cicuta poul- 
tice. 

At the commencement of bubo, the ol in other inci- 

pient to proem ;: itn. For this purpose, as 

for the cure of chancre, abundance of mercury was formerly 
thought the only means; but it was rubbed liberally into the 
affected groin, in the form of ointment, under the erroneous 
impression that the mercury would pass through the gland. 
The same practice is still continued, and with much effect, in 
promoting a rapid absorption of the tumour. (See sub-section 
^nations of mucous orifices, (p. 359.) 

When pus appears to have formed, the softening of the 
tumour must be encouraged by the application of a common 
poultice ; this may indeed be applied in every stage. When 
the matter approaches the surface, the abscess should be 
opened, early and freely, to prevent the formation of indolent 
and thin flaps, which often require to be burned off with caus- 
tic, before the cavity can be healed. It happens not unfre- 
quentlv. that a bubo becomes indolent, and refuses either to 



384 scurvy. 

advance or recede. To open a sore of this description would 
be imprudent. In this state of the parts, blistering is often 
very useful, and the ointment of white precipitate, or the blue 
'butter, with one drachm of powdered camphor, and one scru- 
ple of powdered muriate of ammonia, will be found an t_.\< cl- 
ient application. For our views on the treatment of gonor- 
rhoea, we refer to the sub-section on termination of inflammation 
in suppuration, (p. 31 

Scurvy. — Ti; ial symptom of scurvy is an effusion of 

blood from the superficial blood vessels, and i ranee in 

spots, resembling what arc called blood blisters, man 
under the cuticle. This, however, and th : debility 

which accompanies it, are common to two di huh dif- 

fering both in the i inces under which they arise and in 

the character of their a land scurvy 

and sea Bcurvj . mel with at 

every period of life, but principally affects persons of v 
and delicate constitution. It i 

and pains in the limbs, to which 
shivering, nausea and von 

monk appears first on lb • the 

thigh, arm, and trunk. 

are numerous on the inside of the □ rticularh 

the gums, tonsils, and lips. It i^ from these that the 
bleeding generally occurs; but as the di Mood 

flows also from the nostrils, lung 
all these parts are found, on examination ai: 
with spots, similar to those which show then . the mu- 

cous surface of the mouth. It is : 
by the absence of spoo - .. tin- gin. 
tiniruished from sea scurvy. 

The taih(», both remote and immediate, are obse 
among the former are mentioned, on l'. 
impure air, and anxiety ; on i 
ranee. The 

of the si pulse and 

dence of exhaustion ; sometimes, in full, 
which have the appearance of requiring 
sometimes the general health 
This confusion of cai 
rare instances which are met with at 

many years since, when ti, . the 

larger European cities, th, 
similar to those which produce 

The ravages o( sea-scurvy forme 
est obstacle to the prosecution of v. 
prevention, one o( the greatest triumpl I and 



scurvy. 385 

science, from the time of the celebrated expedition of Vasco 
de Gama, in which fifty-six men were lost by this then un- 
known malady, to that of Ca plain Cook's voyage in the Reso- 
lution, this disease constituted one of the most serious evils 
attending maritime adventures. 

So late, in fact, as 1741 , the fleet under the command of Cap- 
tain, afterward Lord Anson, lost half the crews in the space 
of six months from the time of leaving England. 

Some parts of the description of this disease have been an- 
ticipated, in speaking of purpura. There is the same weak- 
ness and inactivity, with pale, bloated complexion, and a swell- 
ing of the lower extremities. If the gums are examined, they 
will be found spongy, disposed to bleed, and frequently swol- 
len to an enormous extent, and seem as if in a state of decay, 
while the teeth are loosened in their sockets. 

The skin is generally smooth, shining, and covered with bluish 
or livid spots, not rising above the surface; and these often coa- 
lesce, so as to form large blotches. Wherever ulcerations have 
existed, they break out again, and discharge a thin offensive 
fluid mixed with blood. A soft, spongy, putrid clot soon forms 
on their surface, which is with diiiiculty removed, and when 
removed, quickly forms again, followed by a fungous excres- 
cence, which has the appearance of liver. When this has 
been extirpated by the knife or caustic, it is reproduced in a 
few hours. In the last stage of the disease, blood is discharged 
from the intestines, and even from the bladder: and the debi- 
lity is so great that tin -t motion will produce fainting 
and even death. Yet during the whole course, the sense of 
pain is ^ I i ^ 1 1 L or wanting; and the spirits often so far outrun 
the physical power, that the patient, if roused by the stimulus 
of hope or fear, will often attempt a violent exertion, and 
perish in the very act. 

The proximate cause usually assigned for the symptoms of 
scurvy, is a putrescent state o(^ the blood ; but the remote cause 
is unquestionably the exclusive employment of salted animal 
food. We say exclusive: for it appears that the free use of 
(rc^\\ acescent vegetables, or of vegetable acids in any form, 
will counteract the influence of the salted provision, and ena- 
ble the stomach to form chyme of laudable character. In 
long voyages, during which fresh vegetables cannot be de- 
pended on, scurvy may be effectually prevented by providing 
an ample supply of citric acid or lemon juice. This was one 
of the improvements suggested by Captain Cook, to whom, more 
than to anv other individual, belongs the praise of having dis- 
covered the means of resisting this formidable enemy. This, 
however, was not the only improvement which this skilful na- 
vigator introduced into the dietetic regulations of a voyage. 

49 



386 scurvy. 

The quality of the food and water, the clothing and personal 
cleanliness of the men, and the ventilation of the vessel, were 
all objects of his attention ; and such was the success of his be- 
nevolent exertions, that he was enabled to fulfil his celebrated 
voyage of three years and eighteen days, with a company of 
one hundred and eighteen men, in all latitudes from 52 c North, 
to 71° South, with the loss of but one individual from disease, 
and that one, a man who was apparently consumptive when 
he commenced the voyage. The example thus given has been 
worthily followed up 6ince his time. At the present day sea- 
scurvy is, in the navies of civilized nations, a rare disease. In 
our own vessels, private and public, it is effectually prevented, 
by allowing the crews a sufficient proportion of vegetable food 
and vinegar, by improved means of preserving water free from 
impurity, and, on long voyages, by furnishing lemon juice, 
which is still acknowledged to be preferable as a preventive 
to any other article. The great efforts which have been made 
of late years to promote cfeanKniM ain ; en, to discou- 

rage the me of ardent spirits, and to substitute therefor the 
more innocent stimulus of tea or coffee, have undoubtedly con- 
tributed, among their other good effects, to the diminution of 
this repulsive and dangerous disease. 



CHAPTER III. 



MEDICAL PRACTICE, OR TREATMENT OF INTER 
NAL DISEASES. 



True to our original intention in offering this work to the 
public, we shall avoid all those arts by which the composers 
of treatises on domestic medicine, have endeavoured to encou- 
rage the credulous in the belief, that, by a few hours' study, 
and an occasional reference to a book, they could supersede 
the necessity of advice from those whose lives and observa- 
tion are devoted exclusively to the study of disease. We shall 
endeavour to engross, in the present chapter, such information 
only, as may be safely and advantageously communicated to 
the intelligent who are not of the profession, in order to ena- 
ble them to save human life and suffering where higher as- 
sistance is inaccessible or unobtainable in time, without en- 
couraging that rashness which induces the empiric, and cer- 
tain ignorant professional sectaries, to rush into fearful respon- 
sibilities, unnecessarily or criminally. We ardently hope 
that the result of our labours will be such as to leave us 
chargeable with no follies committed in the sick room under 
the sanction of our authority. 



section I. 
Fever. 

The symptom essential to fever, is an altered condition of 
the nervous system, in consequence of which, the sensations 
of heat and cold no longer correspond to their usual causes; 
in which cold is felt, notwithstanding the presence of a warm 
atmosphere and abundant clothing, or heat notwithstanding 
their absence. Together with this, there is usually a rapid 
pulse, headach, and nausea. Fever, in this sense, accompanies, 
or is ■ symptom of, various other diseases, particularly inflam- 



388 INTERMITTENT FEVER. 

mations; but the term fever, or general fever, is applied to a 
state in which the febrile action is dependent on no external 
or visible local disease. 

Intermittent Fever. — A regular paroxysm of intermittent 
fever consists of three stages; and may be thus described. 
The patient first exhibits evidence of languor and debility, 
unwillingness to move, and a disposition to yawn en motion, 
as if aroused from sleep. At this period, the extremities, if 
examined, will be found cooler than usual, though as yet no 
change in temperature is obvious to himself. Presently the 
chill commences, invading the hick and then the- rot uf the 
body, with a progress which is felt and described as crec 
or crawling. The state of chill, when perfect, is marked by 
a sense of extreme cold, which demands instant augmentation 
of all the usual appliances for warmth. possible 

approach to a fire, and additional clothing, or the protec 
of a bed; by all which, ho it little reliei 

the same time, there is a tremor or shivering, usually more 
violent than the impression of external cold proc! \\ on 

the moat Susceptible, being wholly beyond the control of the 
sufferer. At this time, however, if the skin be felt with the 
hand, it will be found warmer than usual, notwithstanding the 
chilliness of the sensation. I lain time, the sense of 

cold begii, tit, and occasional hot fl ;.ced. 

This state of things it. ic approach of the second - 

By degrees, the m and that of unnatural 

heat ensues, the heat of surface as manifi the touch 

continuing undiminished or i; _. With this chai 

heightening of colour is deveh r many parts, and 

•tally in the (ace, which becomes of a bri let. The 

heat and led: :iore and more marked for a time, 

the skin continuii it declining in hars 

the third to all 

the symptoms. The I ady becomes cool, the 

countenance I all things return, 

for the most part, to their natUl 

There are many other appeal iliar 

to each, or common to all the s which 

it will he proper here to notice. In the cold stage, the 
is frequent, small, and often irregular; ihe breal \ious 

and sighing, sometimes attended with cough. In the hot 
stage, the pulse becomes regular, hard, and full, and increases 
in these qualities, till the 9 

piration becomes more full and free, but continues frequent 
and anxious. In the sweating Stage, the pulse bece. 
and less frequent, returning :ly to its natural ! 

the anxiety and difficulty of breathing arc remc 



INTERMITTENT FEVER. 389 

The appetite, of course, disappears from the commencement 
till the conclusion of a paroxysm, and, in general, an ahsolute 
aversion to food takes its place. Together with this, there is 
often sickness at the stomach, and vomiting of a bilious mat- 
ter: this may occur either in the cold or hot stage, but is most 
common in the former. Thirst and dryness of the mouth 
and throat continue during the whole paroxysm, but abate as 
the sweat flows freely. And, lastly, headach, attended with a 
peculiar throbbing in the temples, together with pain in the 
back, and often in the limbs, must be enumerated among the 
symptoms of a paroxysm of fever. 

The interval between the paroxysms of an intermittent, is 
a period of comparative health: and the time which elapses 
between the commencement of successive paroxysms is that 
which determines the type of the disease. If this period is 
twenty-four hours, the fever is termed quotidian or daily; if 
forty-eight, so that the second paroxysm occurs on the third 
day, counting from the first, inclusive, it is a tertian; if seven- 
ty-two hours, a quartan. Regular intervals are rarely pro- 
tracted beyond this period. 

It may happen that a fever consists only of a single parox- 
ysm, terminating entirely in the first sweating stage. When 
this result occurs by art, it does not prevent the disease from 
being ranked as intermittent. Hut a lever having essentially 
but one paroxysm, has been termed ephemeral. An epidemic 
of this ephemeral character once prevailed in England, and 
was called the sweating sicki; 

It is foreign to our purpose to enter into the much disputed 
question of the immediate cause or intimate nature of lever. 
As respects the remote OT external causes of intermittent, they 
are now generally allowed to be marsh miasmata; that is, the 
exhalations arising from vegetable substances, partially im- 
mersed in a moist soil, and acted upon by the rays of a hot 
sun; although it frequently happens that febrile miasma ap- 
pears to be generated independently of this precise combina- 
tion of causes. Very many of the rivers in our middle and 
western states, on the margins of which springs a luxurious 
tation, especially if their banks are low, and periodically 
inundated, are favourite haunts of the affection. But there 
are facts in regard to the salubrity or unhealthincss of river 
situations, which are difficult to reconcile with any precise 
theory ; and our own Schuylkill furnishes an example of a river 
flowing on quietly from year to year in the same channel, 
and nourishing the same vegetation on its borders, yet in the 
course of a few years completely changing its character, so 
that spots in its vicinity once sought for most desirable and 
delightful retirement, have come to be avoided as if infested 



390 INTERMITTENT FEVER* 

by pestilence. We have dilated on this subject in the chap- 
ter on Hygiene. 

It is worthy of remark, however, that intermittent fever is 
sometimes generated in very limited localities, from causes, 
which, though strictly analogous to thoM which induce its 
action on a large scale, may be easily overlooked or misun- 
derstood. Jn fact, cases occasionally occur among children or 
peculiarly susceptible subjects, even ill the midst of populous 
cities, and where the drainage is apparently perfect. They 
are usually found in very Confined situations, and especially in 
cellars, and can he explained only by admitting the presence of 
a local malaria in such situations, from the vegetable remains 
which are allowed to accumulate, and the moisture with 
which they an: iurround< <l. 

The treatment of intermittent fever divid. naturally 

into, first, the raanag< tiring the parox\ 

condly, that proper during the interval Ai reapecui the 
former, it a toe obviotli dure 

is to obtain n means of the ge. The ob- 

ject of ait, then, Would seem to be to accelerate as mu 

ale the aceeai of Ihii in otbei to shorten 

the cold lit; for, when the not lit is once induced, t; 
ing b seldom long in following it. To accomplish this object, 
besides indulging the inclination of the patient for warmth ex- 
ternally, we supply him lai th warm diluent drinki 
hot barley water, flax-seed ioi ige or balm 
unless the stomach be irritable. These aiti to diliuse 
warmth through the system, and, if retained on the stomach, 
are presently carried oil' by perspiration. El D P Im D I '• ctcd 
by vomiting, they are not always injurious, for 
a tendency to the BUriai e« II at, spintll 
punch, &c., acl injuriously, by rendering the hoi e of 
much more intensity than it would othe i be, and 
thus cause tinned tha nation. Laudanum and i 
phor are frequently employed to shorten the cold it _* 
first is liable io th n already u:_ nous 
articles. Camphor is what is termed a di: and, 
therefore, well suited to effect the purpose. A tea-apooni 
paragoric tincture, which combines the virtues of opium and 
camphor, may be often given With goo 

mencement of the cold stage of an intermittent, combined with 
the sudorifica above alluded to. When much headach is 
sent from the commencement, and particularly if the patient 
be troubled by ineffectual retchings without vomiti 
highly proper to give an emetic of a grain oi' antimony with 
twenty of ipecacuanha. At the end of -five ort 1 

minutes the dose may be repeated, if no cmesis be prodi; 



INTERMITTENT FEVER. 391 

Warm water should he taken freely to promote the operation-. 
This dose is proper for an adulr. 

But the most important consideration in intermittent fever 
is, how to prevent the return of a paroxysm. For this purpose, 
the Peruvian bark, or its preparations, have been employed al- 
most exclusively, from the time when their virtues became 
known to the civilized world. 

In what way or by what law of the system, (he cinchona 
produces its etlects, it is difficult to say. The general charac- 
ter of bark, is that of a tonic; and in this view it is generally 
prescribed for debility, more particularly for the debility inci- 
dent to, and consequent on fever. The fact that the parox- 
ysms of fever are arrested by the administration of a few 
grains of bark, is among the best authenticated, as well as 
most remarkable in medical science. This property, we may 
add, is not confined to the Peruvian bark; other bitter barks, 
woods, &c, such as cascarilla, gentian, quassia, and chamomile, 
likewise possess it: but their virtues are seldom appealed to 
except as matter of curiosity. A modern improved method, 
by which the use of the hark in substance, has been super- 
seded, is to extract the bitter principle, or quinine, in the Ibrm 
of a sulphate. This beautiful salt, which is now manufactured 
in great abundance, in Europe and in this country, has taken 
the place, almost wholly, of the old forms in which bark was 
administered. In exhibiting it, the hot rule is to commence 
its use immediately after the slow of the paroxysm, and con- 
tinue it at intervals of one hour in quotidian, two hours in ter- 
tian, and three in quartan airue. In order to secuie a proper 
condition of the lyatem for the exhibition of the tonic, it is es- 
sential in son.' i exhibit lome cathartic medicine, if the 
evacuations are not spontaneously regular. 

If the case be a protracted one, the liver and spleen almost 
invariably become diseased : ami this itate is generally accom- 
panied by a jaundiced hue of the eye. It is then proper to 
have two doses of five grains of calomel taken at bed-time on 
successive evenings, followed by a little oil, or salts, in the morn- 
ing, if the calomel does not operate by nine o'clock : this should 
be done before exhibiting the tonic. 

When, under the use of quinine or bark, the paroxysms do 
not cease, but occur at longer intervals, we are gaining ground, 
and may calculate on success with a little delay. When, on 
the contrary, the intervals grow shorter, we are losing ground, 
and may feel assured that some additional treatment is neces- 
sary to moderate the violence of the hot stage. The saline 
draught and the neutral mixture, if there be sickness, and the 
sweet spirits of nitre given in the dose of thirty drops every 
half hour, will often accomplish the purpose: they should be 



392 INTERMITTENT FEVER. 

aided by cold drinks and affusions, or even by the lancet, 
the pulse is very high, the skin very hot and dry, and tl 
roxysm long. Sometimes ihe inter ndered in 

feet by the continuance of -an obscure, 
through the sue.) finer it age and the interval a hould 

not be given, under these circun til the intern, 

is rendered complete; which may b 

or two di ilomcl, ai xhibition, 

during the interval, of an imV v e root, in 

the proportion of one ounce to the pint of hot water, a wine- 
glassful i" be taken, cold, . the interval and 
the sweating stag 

Tli< od bark are p 

tplicabie by tli«* addition of mi 

tions of sulphate nd opium. The two foil 

jority of chilli 
portion of th< 
rode* 

scription ■ intend* d for those who 

the form i i pills, — the second, tin a dis- 

t for that I sdninistratj 

1. T i Sulphate of nnii 

Bulph ii. 

Minn in j ii. 

Gum Arabic in powder 

Mak 

divide the no isi into 

IX>^ :>iil. 

9, Ti Sni 

Sulphate o( cop] ii. 

Put them in phial, \\. ounces of 

water, and shake them a 
Then a 

F.lixir of vitriol, 
i.lanum. 
Shako the phial again, and then till it with v 
Do>e — a table spoonful 

The medicine, given 
of the interval, should be continued till bed-time on tin 
on which the chill is missed tor the first timo, and this day 
should be noted. 

There is a strong tendency, in an mum :iich has 

been checked, to return on the seventh, fourteenth. or tw« 



CONTINUED FEVER. 303 

first day: to prevent this disaster, a dose of one or the other of 
the above prescriptions should be taken in the morning, at noon, 
and at night, on each of the days here named, counting from 
the day on which the paroxysm first failed to appear; viz. the 
sixth, seventh, thirteenth, fourteenth, twentieth, and twenty- 
first days. By faithfully following this direction, the patient 
will verv rarely experience another attack, for at least six 
months; which is ,t< long an indemnity as can be reasonably 
asked by those who continue to reside in an infected district. 

Although quinine may be almost with certainty depended 
on for remedying an attack of intermittent fever, and the sys- 
tem remains secure for a time, continued exposure to the 
same malaria will again induce it, and even removal to a 
more salubrious climate is not always a safeguard. The indi- 
vidual who has frequently suffered, sometimes retains a re- 
markable susceptibility to the disease for years, and even for 
a whole lire. In such individuals, simple exposure to cold 
will often be sufficient to induce an attack. For awhile, 
these relapses are cured with the same ease as the first attack; 
but after some time the quinine seems to lose its effect. Un- 
der these circumstances, the Fowler's Solution, an arsenical 
preparation, has been found a valuable substitute. It is em- 
ployed in dosei of ten drops, taken at intervals; but it is an 
Article altogether too dangerous for domestic ill 

Continued \ paroxysm of intermittent, as above 

described, may be considered ; or model of all febrile 

<>ns, to which all bear more or less of resemblance. But 
there i« a large class of fever* in which the regular sequence 

.upturns which belongs to the intermittent fails to be ob- 

•!. The aci« Btially with chill, which is 

succeeded by a sensation of heat. Pain in the head and back, 

if appetite, thirst and . are also present. But 

tier wholly from regular intermittent in the fol- 
lowing circumstances. The commencing chill is less vio- 
lent, and often not attended with absolute rigour or shaking; 
the hot stage, when fully formed, may continue with little 
change in the degree of heat for many hours or even days; 
and there is no regular termination by sweat. The natural 
state of the functions, instead of being restored at the expi- 
ration of six, eight, or ten hours, oftentimes does not return 
for as many weeks; but once restored, the whole force of the 
morbific action is exhausted, and there remains no tendency 
to a new paroxysm. Such is the general character of continued 
fevers. But as under this class are embraced diseases of very 
different character, it will be better at once to separate them; 

ring for distinct notice the bilious, remittent, or yellow 
fever, as likewise the petechial or spotted fever, and the ma- 

oil 



394 CONTINUED FEVER. 

lignant typhus, all which arc diseases of very fatal tendency, 
and considering at present the common inflammatory or con- 
tinued fever, together with the mild typhus or slow fever, 
which is the form into which the former passes when pro- 
tracted naturally. 

The commencing symptoms of continued fever have been 
described. Its approach is insidious, and generally the stage 
of chill has already been succeeded by heat before it attracts 
notice. Then the patient is found with Hushed face, suffused 
eyes, hot skin, quick, hard pulse, tongue loaded with secre- 
tion, thirsty, very restless, and in the I -;htly 
delirious, yet without other pain than that referred to the 
head, and an achil lion in the back and limbs. The 
disease is seldom allowed to make progress without interfe- 
rence, for experience fully proved the utility of at- 
tempting to arrest it, and so clearly pointed out the means of 
so doing, that these means are probably tin rted 
to. The relief urgently demanded at this period, is to be 
gained in a very large proportion of cases by the simp! 
hibitlOD of an emetic; in a smaller number by the 

medy, preceded by bleeding; and a still smaller, perhaps] 
bleeding alone. The latter is most ial when it pro- 

duces free perspiration and excites vomiting, which it not un- 
frequently docs. The rejection of the contents of the 

inach, followed by a free d of bile, g 

to the head, and oily to at 

and break up the fever. Should the latter not ha; 
patient obtains after some hours a remission of the^symptoms, 
the pulse becoming slower and softer, the skin more cool, 
countenance brighter, thil mind clear and tranquil. 

These favourable changes, when transitory only, arc most 
usually remarked in the early pari 

ning an aggravation again taki- When this alternation 

has continued for a lew days, one of two things tsk 
Either gradual improvement occurs with tl. ap- 

petite, l natural coolness ol the >kin, the restoration of the 
strength, &c, or the fever cha: v i • The return of 

daily febrile action ceases to be I . or becofl 

slight. The pulse sometimes falls below its natural standard 
to sixty, or even fifty beats per minute. The body is pale and 
cool; but, on any exertion, a sudden flush will be noticed in 
the cheeks, especially in children, which subsides when the 
occasion which produced it is piimod The disposition to 
speak, or even to reply to questions. The adult 

answers after a moment's hesitation, and in a d: g :onc; 

the child speaks in whispers. Little attention is given u 
rounding objects: the sight, hearing 



CONTINUED FEVER. 3&5 

certained, smell and sense of feeling are benumbed; the eyes, 
when examined, have a staring expression, as if scarcely af- 
fected by light, and the pupils will be observed unnaturally 
dilated. The balls are often suffused with tears. There is no 
thirst, and little appetite, though scarcely an aversion to food, 
for small quantities are willingly taken, especially by chil- 
dren. The alvine discharges become slow and sluggish. From 
this state the patient may and often does recover, after a te- 
dious confinement of eight, ten, twelve, or sometimes twenty 
weeks, with extreme emaciation, and almost total loss of 
strength. If fatal, death usually takes place in the third or 
fourth week, though such a termination may occur at any 
time. Among the symptoms of a graver character than those 
above mentioned, are what is called coma, and delirium; the 
former being a deep, heavy, protracted sleep, from which the 
patient is roused with some difficult}-; the latter evinced by 
a low muttering of incoherent sentences, and a half-dreaming 
state, during which the most singular phenomena are occa- 
sionally noticed almost to the last. The attention can be re- 
called, with some effort, to what is passing around. Recovery 
in protracted cases is sometimes followed by wild insanity, 
which, however, is almost always curable in the course of a 
few months. 

Such is a sketch of the mild typhus or slow nervous fever 
of our own country, a disease most observed, perhaps, in our 
northern and middle states, but known very well to practi- 
tioners at the west and south. Its medical treatment belongs, 
of necessity, exclusively to the profession ; and there is less 
occasion for opening the subject here, because the slow and 
gradual progress of the symptoms affords ample time and op- 
portunity to obtain medical advice. 

But to that important part of the direction of these cases 
which falls under the denomination of nursing, attendance, and 
general management, we wish to call especial attention. 
These subjects are too often overlooked or neglected in prac- 
tice, for the very reason that their practical application re- 
quires that patience, firmness, self-command and perseverance, 
which, though among the best, are among the rarest qualities 
of our nature. 

Clean ti/wss may be justly ranked as first in importance 
among the duties of a sick-room. Between the indolence 
which avoids all avoidable trouble; the indulgence which can- 
not bear to inflict immediate inconvenience for the sake of 
subsequent benefit, and the fear which shuns the responsibility 
of any decided measure, even the necessity of neatness is too 
often lost sight of; and, among those who should both know 
and do better, negligences are permitted which the parties 



396 CONTINUED FEVER. 

concerned would blush to see exposed. We do not hesitate to 
lay it down as a general rule, that there is no state or stage 
of fever, in which the exposed part of the person may not be 
claily washed, the linen about the person daily changed, and 
the bed daily made. Even in cases of extreme debility I 
things may be done, so as to afford far more permanent com- 
fort to the sufferer than the temporary inconvenience caused, 
provided the process be managed with g ■ and discre- 

tion. For the mere purp< 

may be employed ; but there is a refn lueuce in the 

application of cold water to the fac< ring 

the heat of continued fever, which is sometimes indescribable, 
and which is not attended with any subsequent il The 

skin for a time is relieved of its burning sensation and dn 
becoming soft, moist, and natural in temperature, and this ef- 
fect will often continue for a considerable time. The mouth 
and teeth should not he neglected at an;. .nd as IOC 

his strength will permit, tli I should be encouraged to 

attend to them for I. - of the 

sick-room, the nee .oris 

likely to become offensive, little need be - - the 

nuisances, however, which are apt to collect in room, 

and to which too much indnL are the 

boxes, papers, &c, the contents of which are hut partially 
consumed. Let them be banished without hesitation, as soon 
as their i> •ntinucd. 

Temperature and ventilation. Patients almost always know 
when the bed-clothing is insufficient, or the room too cold; but 
the due caution to prevent the body from being too much co- 
\cied, or the room over-heat- 

Attendants should be exceedingly attentive- on this point, 
complaint on the part o( the ; should be prevented by 

anticipation. Ventilation rtant at all 

though more difficult to i In comfort in 

winter than in summer, it may be managed at all I 
The air can be suffered to gain admittance from a door. i: 
from a window, in the course of 

time to dissipate any noxious effluvia. A w indow op< 
downward at a distance of fifteen or twenty feet from the bed, 
is almost always available for this pur;> 

The subject of administering food and drink is. - the 

source of perplexity to many well-mear: 
though perfectly satisfied thai the natural good 

guide in regard to this matter in health, cannot 
suaded that this is equally the case in disease. To a j 
tent, however, Mich is the fact. During the early | 
while active symptoms arc present, th 



CONTINUED FEVER. 397 

food is not only absent, but an absolute aversion to it is gene- 
rally present. Liquids are sought for with great avidity, and 
the purest and simplest water is the most agreeable. As the 
ardour of the fever subsides, the desire for drink, especially for 
cold liquid, is lessened, and often some warm slightly nutritious 
beverage as tea, gruel, arrow root, &c, is found very palatable. 
As the fever still farther abates, and the previously coated 
tongue clears, the appetite for solids returns, though the desire 
is generally found to be easily appeased. In the protracted 
cases which we have attempted above to describe, there is 
rather a willingness than an absolute desire to eat, rather a 
of emptiness than appetite, and indulgence, while it gives 
little pleasure, is yet found to relieve an uneasy sensation. 

For the most part, we apprehend, these promptings of nature 
may be depended on, provided we are careful to exhibit only 
the milder articles of food in small quantities frequently re- 
peated. Some exceptions or limitations to the rule occur in 
children, in persons greatly advanced in life, in those whose 
minds arc enfeebled by long illness, in patients who sutler from 
habitual indigestion, and in persons prone to habitual excess. 
To lay down precise rules for the management of each of these 
s of patients, would require an elaborate essay, and the 
consideration of many topics which do not enter into our plan. 
By the exercise of sound discretion serious errors may be 
avoided, and even n . when not too work out their 

own remedies. The folio wi ins, however, the result, 

of some observation in this may not be found useless. 

Persons of mature ai^e and of sound mind, may be indulged- 
in simple water at any time, to any extent they desire, if not 
affected with obstinate vomiting. Children and childish per- 
sons may be limited in regard to the quantity, but not as to 
the frequency of the indulgence. The same may be said with 
more confidence of the simple infusions, as toast-water, balm 
&C, because, being somewhat repulsive in taste, they are 
not likely to be taken in excess, even by the most thoughtless. 

To children, as soon as the desire for solid food returns, it is 
perfectly safe to allow a dry biscuit, which requires some ac- 
tion of the teeth to put it in a condition to be swallowed, and 
the very trouble the indulgence costs is the best safeguard 
against exce 

■ patient of any age should be urged to eat, nor should the 
nutritious liquids above referred to, the gruel, &c, be insisted 
on, unless by express order of a physician. Many persons are 
averse to these preparations, and want no food till they are 
able to return to their ordinary repast of tea or coffee and 
toast, or even till they can indulge in some light animal nourish- 
ment. 



398 CONTINUED FEVER. 

When an experiment in diet which is regarded as doubtful 
is to be tried, let the trial be made in the early part of the day. 
An article not thought of till the hour of dinner is passed, if it 
require any preparation, had better be deferred till next day. 
This rule is peculiarly important during the first few da- 
convalescence, while there is still a tendency to febrile action 
towards evening. To take this period for an indulgence in 
itself allowed to be of questionable character, is obviously in- 
consistent with wholesome discretion. 

No rule can be given in regard to these cravings which are 
felt by conval< for such i 

dried beef, pickled oysters, &c. 'I lication sought in 

these caa of the taste rather than the appetite, a: 

taste is all that is needed. We have heard an anecdote of a 
distinguished practitioner, who, in reply to an importunate re- 

ofa patient, that she might be indulged in rid 
tainlv. my, dear, a tea-spoonfall three times a da] 
any thing need be feared, it' tl. but small en< 

Although pti *.ment in 

department, we deem 006 subject, — I .lvinc 

discharges in fever. — tOO important to pass 01 
The - still fre- 

quent It may be ohviafc :lation of 

diet, such as will he noticed under the head of ; or 

by administering one of the cathartics in common use, 
quantity just sufficient to effect 
solicitude felt on thai subject by alt 

Carried to e\i eflB, and leads to an i ncc with 

the natural t< ndencies and demand) Of L The 

y obviously is to appropriate \ hly the nutri- 

ment which enters the stomach, ery small 

residuum, and that in a state not very favourable to 

taneous expulsion. If a too 

it will probably become a source o( irritation: but 
evacuation be unduly urged, the d is not propers 

fected, and the benefit of the nutriment i~ lost. 

Other inconveniences of will be con- 

sidered h rve that, 

in convalesce] r. only the mildea i kmM 

be employed. Generally speaking, the use oi >ome mild 
charine or sub-acid firu wed prunes or tamarind, will be 

sufficient; or, if any proper medicinal article l little 

confection of senna, the rhubarb pill, or a tea-spoonful I 
in emulsion, may be substituted 

On one subject connected with the management of 
room, we must be excused for speaking KHM sev<. 



CONTINUED FEVER. 399 

We allude to the admission of unnecessary or improper at- 
tendants and visiters into the apartment. Not only in fevers, 
but in the whole range of nervous affections, even when mild, 
it is of the utmost importance to prevent all unnecessary ex- 
citement of the senses or the mind of the patient. The room 
should be darkened, to relieve the eye, and a heavy tread, or a 
creaking shoe should never be tolerated. In severe cases, and 
particularly those attended with giddiness or great irritability 
of stomach, the mere presence or absence of a continued mo- 
notonous sound or an unvarying motion, such as the oscilla- 
tion of a rocking-chair, will sometimes determine, as we know 
by actual experience, the result of life or death! A nurse 
who argues and disputes with others, in the presence of a pa- 
tient, should be immediately dismissed. A practitioner who 
so far forgets the duties of his station, as to raise his voice, or 
indulge his temper, or annoy the patient with disagreeable and 
irrelevant conversation, or alarm him by appearing after in- 
dulgence in dissipation, whatever be his talent or standing, 
should be tolerated only when no more reasonable or credita- 
ble assistance can be possibly obtained. 

Religious services in the sick room should be very short 
and very quiet. Singing, and especially singing in concert, 
is very reprehensibla A clergyman who knows the true du- 
>>[' his calling, and prefer! the true service of his Master, 
to tin ie of petty influence or the gratification of a silly 

vanity, will always consider the advice of the medical atten- 
dant, both with regard to the time and duration ofhifl 
and lie should slso recollect that, either from respect or policy, 
the practitioner generally avoids carrying his expressed cau- 
tions on such subjects to the extent which justice to the pa- 
tient demands. 

Hut what shall to the kind friends whose anxiety 

for the patient induce them to insist on admittance? The face 
of a friend is often more serviceable than medicine, more in- 
vigorating than wine! but the faces of a dozen, are worse than 
intoxication. 

Independently of the noise and excitement produced, the 
mere presence of numbers poisons the very air which the sick 
man breathes, and renders even the healthy liable to contract 
disease. This habit of crowding a sick room is chiefly no- 
ticed among the vulgar, and is often tolerated by anxious 
friends, for fear of giving offence; but let it be remembered 
that none but the weak and prejudiced can be offended at be- 
ing deprived of the power to injure those whom they profess 
to love; and where health is at stake, the value of such friend- 
ship is a negative quantity* 

There are two pests of the sick room with which we have 



400 BILIOUS REMITTENT AND YELLOW FEVER. 

no patience. They are of both sexes, but of totally distinct 
species, — though too frequently, both are relations of tht pa- 
tient. 

The first — mild, kind, and prompted by the best of mo- 
tives — is a soothing and low voice, which flows, however, with 
an almost ceaseless current, inquires into all the feeln ig 
the patient and all the directions of the physician: 
former to be of good cheer and trust in Providence, hoping 

that every thing is for the best; but states th, , 

and Mrs. 13 , and little C . all laboured under just such 

symptoms — that the first was saved from Death's door by good 

Dr. D , under a totally different course of treatment — that 

the second seemed to be doing well for a long time under the 
attending physician, but died unexpectedly on the twentieth 

day ! and that poor little C recovered directly under tl. 

of Cayenne pepper and the hot bath! The kind friend If 
the apartment with ti. cc that the patient looks 
ill. but exhorts him to be of i:ood cheer and hope for the 
quietly breathing in the ear of the nurse or \\ ife, — u My dear! 
It's a very b.. not better call in Dr. 1) r" 

The other annoyance is of an opposite character — Ko 
Strong, active, and either blustering .inc. accordi 

the lex — totally incognizant ol and incredulous of de- 

bility. — it inters the chamber with a hurried or a heavy t 
If of the masculine variety, it Itl the patient in a 

tone, in something like the followi — u Come! come! 

This will never do! l! You would be well 

enough if you would but think so. and throw your medicines 
out of the window. Nurse! you n Ser your pal 

spirits to sink. I have cone through as much trouble and expo- 
sure as any one. in my time: but I ncv 

never sick I day in my life. This all conies of over indul- 
gence and him' ihould ride out and take the air, 
and call your friends about you. and you would be well direct- 
ly. Here, Nurse! 1 have brought him a bottle of win- 
mind the doctor and h'\< 01 > 1 had nothing to do this 
evening, 1 thought 1 would just step over and sit an hour with 
him to keep up his spirit- 

We have Buffered less than many from the folly of tl 
friend/// homicides, having made it through life a principle 
of action always to cause their immediate ejectment, or to ab- 
dicate ourselves — but having witness deniable suffering 
from such proceedings, and hoping that a few mav be startled 
by these true pictures, into something like a ratior. 
of conduct, we have sketched them from the memor\ 
rner years. 

BiHom Remittent, and Fellow Fever, \> it ia notour 



YELLOW FEVER. 401 

design to enter into the treatment of fevers, except so far as 
to secure the patient against loss of time, when the physician 
is not immediately accessible, it is less important for us to go 
into any examination of the arguments for and against the 
identity of the bilious remittent, and yellow fevers. After 
simply announcing our faith in the fact that all fevers are 
symptomatic of local inflammation, or irritation in certain 
parts, either internal or external, and that its varieties depend 
upon the peculiar organs thus affected, we have only to state 
our inability to discover any difference in the seats of the two 
forms of fever just mentioned, in order to convince the reader 
that we regard them as differing only in intensity. 

The bilious remittent is but a somewhat more complicated 
variety of the common remittent, which we have described 
under the title of continued fever. Its peculiarities consist 
chiefly in a more serious implication of the liver, giving rise 
to mure obstinate constipation, or to a diarrhoea caused by 
vitiated bile, and a yellow or jaundiced hue of the skin; alto, 
a greater irritability of stomach, which is apt to occasion vio- 
lent vomiting, which becomes, in some cases, almost uncon- 
trollable. 

The treatment recommended in the commencement of con- 
tinued fever, generally, is applicable here; but there is even 
stronger necessity for early medical advice; for the disease, it 
left to itself, is much less prone to fall into the low and pro- 
tracted state, and more liable to I rapidly fatal termination. 
As advice is not alwa\ ble, it may be proper to state, 

that the treatment laid down for yellow lover is applicable to 
bilious remittent, when moderately employed; and that, in 
certain situations, the latter, when epi> - often nearly 

as fatal aa the former; into which it finally merges itself at 
certain points on our western wa* 

Yellow Fever has been said to be a disease of comparative- 
ly recent origin. The first distinct account of its appearance 
given at Barbadoea in the year 16 17. It occurred at Bos- 
ton in 169 J. Its first appearance in Europe is referred to 
. when it broke out in Lisbon. After some years it de- 
clined in severity, but recurred with new violence about 1793, 
and since that year has raged with varying intensity in the 
south of Europe, the tropical part of Asia, and the West In- 
It has long been a summer epidemic of New Orleans, 
Charleston, S. ('.. &c, and was repeatedly destructive in the 
city of Philadelphia in 1768, 1793, 1797, 1798, 1799. It 
showed itself more mildly in 1802, 1S05, and 1820. New 
York has also suffered several times. Among the local causes 
which produce it, one of the most active, undoubtedly, is the 
effluvia of decaving vegetable matter; but these are insufficient 

51 



402 YELLOW FEVER. 

without the epidemic tendency; it has been generally believed 
to have been imported, and then propagated by contagion in 
our northern cities. But this is a subject which we will not 
discuss at present, farther than to state, that the belief in its 
importation and contagiousness increases in just proportion to 
the distance to which we retire from those countries where 
the disease is best known and understood. It is termed yel- 
low fever, from the tinge assumed by the skin of persons af- 
fected; black vomit, from the peculiar matter rejected from 
the stomach; and, sometimes, palludal or marsh fever, from its 
local origin. The peculiar symptoms by which it is (i 
guished from other continued fevers, arc the following: — The 
chill is slight, never amounting to absolute shivering, b' 
ne rally accompanied with fain' of the stomach 

exists from the first, and the retching increases with the dis- 
tter vomited is yellow, on the second 
or third day, it becon . ami towards the inina- 

tion, black or of I lour ami resembling cofiec-grounds 

in consistence. The yellow colour of the skin, which is by 
no means peculiar to ' loped on the 

third or fourth day, in ck, and I .d thence 

extends to th» the body, which, in fatal cases, becomes 

yellow throughout The urine, when observed, is of a dark 
saffron colour. The ti irst covered with a moist. 

low ish white coat, then Incomes drier and more discoloured, 
and finally quite black. The time required for the i 
reach its fatal termination . :i some instances, 

not exceeding twenty-four hours, in which I How 

colour of the skin is much leu jly marked. When it 

runs to four or live da] such 

as would lead an inexperienced person to anticipate reco\ 
and often the spirits and - .ours 

before death. When the peculiar vomiting] above mentioned, 
has once taken place, the diaeasa almost ilwayi prove! fatal. 

From the very various opinions rcspe trcatme 

yellow fever, it is not easy to select rul to general 

As in the mildet g tnent 

will be (oi\m.\ sueees>ful. BO in ti. -hare 

the disgrai lure. In the last, however, the general re- 

sult o( experience i be, that aco; • 

■ bleeding carried to the extent ss, is 

more likely than any other remedy a favourable im- 

pression at the outset, to relieve thi hcadaeh. the pulse, 

and check the vomiting. The blood should be drawn in an 
ered or sitting posture, and in ■ rail stream, 
faintness is the sooner induced, and the advai the 

bleeding gained with the 



PETECHIAL OR SPOTTED FEVER. 403 

The effect of the blood-letting in reducing the system, is to be 
immediately followed up by a powerful cathartic; an ounce of 
Epsom, or an ounce and a half of Rochelle salts, for example, 
which must be repeated every four hours till full operation is 
produced. Should this active treatment succeed in controlling 
the primary symptoms, in arresting the vomiting, for exam- 
ple, and relieving the headach, the subsequent management of 
the case is simple. Ventilation and cold affusion, to diminish 
burning heat of skin, must be employed during the remainder 
of the fever, and bark and wine during the period of conva- 
lescence. 

U the salts be rejected, or if the vomiting be severe, a spice 
plaster should be applied, and lime water and milk — one table- 
spoonful of each — may be given every five ibr ten minutes, and the 
moment the retching is lulled, a dose of ten grains of calomel in 
our country, or twenty in a tropical climate, should be adminis- 
tered, in a small portion of molasses or honey, — cold lemonade 
by the half wine-glass at a time may be fearlessly given, after 
this for three or four hours, when, if the stomach be composed, 
and the thirst great, cold drinks should be taken freely. When 
calomel is given in purgative doses, not immoderate in quan- 
tity, the dread of cold after it is in a great degree a prejudice. 
To secure the operation of the purgative without disturbing 
the stomach, ; f BntOffl salts may be dissolved in a gill 

and halt iv hour. Having 

diminished the pul- d the temperature by 

cold effusions, composed th id allowed our purga- 

tive time ' hours are sufficient 

for this,) all our attention should he given to the production of 
perspiration in mi hut when ti. ry threat- 

ening, and the epidemic rapidly fatal, this course should be 
coupled with the; attempt t<> touch the mouth with mercury. 
For the former panose, the followii. may be employed 

alternately, or in buc< ceording to the degree 

of vascular reaction and the ability of the stomach to bear 
The saline draught given every hour; sweet spirits of 
nitre, forty drops every two hours, in a little water: the infu- 
sion n( Virginia snake root, a wine-glassful every two hours ; 
and. if there be little tendency to the head remaining, the Do- 
powder, ten grains every three hours. The two latter ar- 
ticles alternated every hour and a half, with some warm tea in 
the interval, act very powerfully. The mercurial course cannot 
be attempted by the domestic practitioner under any circum- 
stances with safety. 

Petechial or Spotted Fever derives its name from the ap- 
pearance which it exhibits of dark coloured spots upon the 
skin, caused by the extravasation of blood beneath the cuticle. 



404 PETECHIAL OR SPOTTED FEVER. 

As described by European authors, it is a malignant typhus, a 
variety of the putrid typhus, camp, or jail fever, a disease of 
which we have fortunately little experience in this coi 
and of which we shall only remark, that it exhibits in a 
vated form all the symptoms which we have enumcrai< 
belonging to our own protracted nervous fever. A peculiar 
form of spotted fever, however, has been repeatedly epidemic 
in this country, particularly in the eastern the 

descriptions of eye-witnesses, it seems to be one of direct pr. 
t-ion, without any preceding stage of excitement. Jt 
fact, a striking resemblance to malignant ch 
that many very intelligent observers bare maintnii 
with that disease. An eminent physician of New England de- 
scribes it as a nervous fever, in which I 

ing, the torpid or forming dthatof. tend- 

ed together, attended \\ ah pain in th- 

roxysms o . and, for i cool 

skin, a slow pulse, and 
techial eniptii i ipilla- 

., delirium, palpitation, numbness, and in»usccpt: 
to the action of ordinary rubefacient! and bl id sulking 

after evacuations, are much more con.:. < ther 

febrile disease." thor admits that cold:. 

numl - and pui union to both 

i 
very decidedly from other fe brili ic other ! 

it is said that it is only in i ases, 

that i cholera ii it. Ord -esof 

sinking typhus so much res Me common i . that 

without a previous at during 

a paroxysm of oi iroely discern the 

difference. u In it jthor air 

quoted, " I have seen it destroy life within I 
attack, and within one hour ■ ttdenl f.imn; 

sufficiently apprehensive to send for a 

tended with vomiting and diarrhcra; in Ol case 

of cholera. Othei 

iso slight as not to require the patient'- bed. It \ 

equally with respect to its duration. I 
up within a few hours from 

tinues five or seven days; at other times, . ly when it is 

complicated with common typhus, and often when it is only a 
mild disease, it is protracted two. thl 

occasionally two or three months. Dr. Miner, in \. K. Jour. 
vii. k 2'3. The long protracted o 

tinction between this form of dn 1 cholera : but wh 

is recollected that collapse in the latter is often folk 



SMALL-POX. w 405 

stage of reaction in which the disease answers very nearly the 
character oflow typhus, the distinction will appear less marked. 
The most essential difference between the two diseases is, per- 
the circumstance, that in sinking typhus, the brain is the 
chief seat of derangement, while in cholera it is the stomach. 
H J 11 general,' 1 . Miner, " there is greater weight of dis- 

ease in the brain, and coma or delirium is much more frequent 
in sinking typhus than in cholera." J)r. M. tells us that the 
application of blisters to the head relieved the cerebral symp- 
toms; but in the general treatment of this form of typhus, 
nothing but the most active stimulants would answer. On the 
commencement of the attack, heat was applied to the surface 
by means of hot bricks of hot water, etc., while lau- 

danum, alcohol, the essentia] oils, and hot liquids were the in- 
ternal remedies. Neither emetics, cathartics, nor depletion of 
any kind was employed from the time when the character of 
the disease came to be fully understood. Treated on these 
principles, the fever w rally relieved at the outset, and 

convalescence was manifest in the course of six or eight 



SECTION' u. 



uses. 



-Having gone through the consideration of gene- 
ral or simple fevers to a few very remarkable 
n which, aftef a continued fever of some hours, or 
. an eruption is thrown out upon the skin, which forms at 
once the leading characteristic of the allection. and by the pro- 
of which the disease is limited. Such is the case with 
small-pox. This disease commences with many of the symp- 
toms of ordinary fever, chill followed by heat, pains in the 
head and loins, extending to the extremities, restlessness, thirst. 
These usually commence at night, and undergo some remis- 
sion during the day, to be renewed with increased intensity at 
its close. There is often a severe burning sensation in the 
stomach, and a soreness of throat, attended with considerable 
degree of hoarseness. At this time a peculiar odour fre- 
quently arises from the skin of adults, and from the breath of 
children, which is perfectly evident to every one on entering 
the room. The eyes are red and shining, and are often suf- 
fused with tears, while the membrane of the mouth and the 
gums appear fuller than natural. Bleeding from the nose is 



40G SMALL-POX. 

not unusual in children. In subjects of a full habit and san- 
guine temperament, especially women and children, a rose-co- 
loured rash sometimes precedes the eruption, comi n the 
face, and thence passing to the trunk arid extremities. It some- 
times shows itself as early ai the secoi d day, bul n rally 
later, and appears so much like measle-, that even experienced 
persons have been deceived. On the third day. it i> not un- 
common for children to have an attack of com The 
•eruption itself usually appears late on the third. or on the 
morning of the fourth day. about eight] I the com- 
mencement of the (e\ar. It i< teen first on the nose and 
extends to the face and bead, and afterwardi m\ neck, 
chest, trunk, arms and legs. It commences in the form of 
small red circular which, at ant mm h i 
lered, multiply rapidly, and in the course ol two or lb 
iDTade the whole f ftheskia, 1 into the 
mouth, and to the internal membrane <•: 
appearance of the eruption, th 

the head, hack, and loins and the increased h much 

diminished, an nd or 

third dav of tin little 

limpid or wal tip, an illy pass into 

their second or V« n which 

or hemispheric bladder, tilled with 
this, as well as the uent changes, foil 

order of the eruption, ft ward. Ii 

the vesicles flatten at the top, so as to present a e prcs- 

sion at the centre. This change, how 

marked upon the lace, the 
their rounded form much longer. 

full size, the parts around tin in swell jnd redden, and tl 
such an extent in the lace, that the features Can with diff: 
be recognised On the sixth i the eruj 

its form unci' K>ther i 

smooth ami semi-transparent 

whitish. The opacity increases, and the colour .ill it 

reaches that of straw or cream. A mail speck nowi 
the centre ^( each vesicle, which spit ada till 
surface. Mean while the l tilled 

with matter resembling pass. which is called the 

maturation of the panted with an ii 

fever, marked by chills, heat, beadach, thirst, and some- 
torpor and delirium. Thii is a period o\ dai 1 1 the 
eighth or ninth day oi the eruption, the fourth or drviiiL' stage 
commences, ^omo of the pustules break, and dssohai 
matter, which crusts upon the surface: in othus. the crusting 
goes on internally; but all are converted into sol; 



SMALL-POX. 407 

brown, and dry masses, which gradually fall off. During this 
process, the secondary fever declines, and the redness which 
surrounded the pustules, fades and disappears. Each pimple 
requires from twelve to fifteen days to complete its course. 
The whole period from the commencement of the fever to the 
disappearance of the scabs from the extremities is, therefore, 
from eighteen to twenty-one days. The scars left by the 
scabs, are first red, but soon change to purple, and at length 
either disappear entirely, or sinking deeper, become perma- 
nent pits. 

In the above description of the progress of small-pox, we 
have principally had in view the distinct form of the erup- 
tion. The conlluent form differs mainly in the following par- 
ticulars. 1. The previous fever is much moi . assuming 
a typhus form, often with delirium, and sometimes terminating 
fatally. 2. The eruption often appear! on the second day of 
fevew and always earlier than in the di>crete form. 3. It shows 
itself nearly at the same moment in every part of the body. 
1. When the pimples become vesicular, they increase rapidly 
in breadth, and, wherever numerous, tend to coalesce and run 
together. This character, which gives its name to the variety 
of the dim Ined throughout; and when the drying 
process occurs, the face is covered with a continuous scab, 
which falls off in large n ■>. The vesicles, where dis- 
tin< t, never rise into a spherical form, like those of distinct 
small-pox. but are tlat and irregular in outline. (>. Suppura- 
tion t rfectly, and the fluid 
never acquires the deep yellow tinge, and thick consistence, 
which i-s observed in the distinct form. 7. The secondary 
,.ii< at the eleventh day j and is accom- 
panied bv the secretion of an extremely viscid saliva, which is 
difficulty. This is the period of greatest 
i. Torpor and delirium frequently supervene, and the 
patient di 'tic. 

The present treatment of small-pox, displays perhaps one of 
-t of the improvements of modern medicine. It was 
thought necessary, in order to prevent the repulsion of the 
eruption from the surface, and throw out the morbid virus 
more fully, to guard the patient from all access of fresh air, to 
keep his body loaded with clothing, and to supply him plenti- 
fully with hot and stimulating potions. The mortality under 
this system of management was dreadful; being about one out 
of four among adults, and one out of seven among infants. At 
present, the opposite system is pursued. Abundant ventilation 
is allowed; the patient is permitted just such clothing as is 
comfortable, and drinks his water or lemonade at any tempe- 
rature which suits him. The other treatment consists mainly 



408 SMALL-POX. 

in the due regulation of the bowels, in protecting the eye?, in 
controlling the fever at the outset, and guarding against ex- 
haustion in the later stage. 

Aperient medicines are not often needed for the first ot 
these purposes, and sometimes a few drops'of laudanum may- 
even be demanded to check diarrhoea. The second object is 
effected by keeping the room moderately darkened. The third 
purpose, — that of reducing the fever, — is effected by the ordi- 
nary depictive measures, which have been considered undc _ 
neral fever. As respects the fourth, it is certain, that son 
mulus, as that of wine or porter, is sometimes required about the 
15th day of the disease, when the secondary fever has assumed 
a decidedly sinking character. The necessity for this treat- 
ment is pointed out by a weak and failing pulse, dry dark 
on teeth, and low mutt _ lirium. The 
amount of alcohol which can be borne under these circum- 
stances, without causing headach or intoxication, 
prisingly greet It is someti: the com- 

the d ■Pply ■ blister to the to relieve 

cough; ami I be done without regard to the eruption 

on the part. '1 'he hardened mucus and half separa 
which impede thi - of the throat ami nostrils, mi - 

patiently remov* d by syringing or otru i - they produce 

constant annoyance and are a terio Station. 

Small-; i communicable to un- 

protected individuals by contact with, or a near approach to, 
a diseased patient. 

Within what limits the activity of the contagion is confined, 
has not 1) taincd. It is probable that i 

hie of communicating the 

before the eruption appears. 1 that the mat- 

ter of eontagion will remain for a loni; time attached to the 
body ami bed-clothes which h 

sick. unless washed ami exposed to ml that the;,' 

ments, if not duly ventilated ami i in. for a 

considerable period, s -ease. 

Persons visiting patients with small 

mav convey the disease in their persons or clot: 

v isceptibility to small-pa mi- 

versal; hut those who el g I unproli 

may suffer at another. 

It has been maintained by very high authorities, that t 
who have had a regular attack of small- osed 

to the contagion in any way. with entire impur. 
now fully disproved; and. unhappily, il - 
thai a second attack, under - 
than the first; for the case I idividual 



VARIOLOID CHICKEN-POX. 409 

has recovered from the first, fallen victim to the second at- 
tack! This, however, is extremely rare. The cases of a se- 
cond attack, milder than the first, are more numerous, but still 
to be regarded as remarkable exceptions to a general rule. 

Inoculated small-pox is rarely seen in this country, as the 
practice of vaccination has almost wholly superseded true ino- 
culation. As the latter operation is now considered wholly 
unwarrantable, we shall avoid all allusion to its results. 

The term varioloid disease is now applied to small-pox erup- 
tion, as it appears in those who have previously had either the 
natural or inoculated disease, or who have been vaccinated. As 
neither of these occurrences can be depended on with abso- 
lute certainty to modify the character of a subsequent spon- 
taneous eruption, it ifl evident that varioloid must, in its se- 
verest form, be undistinguishable from small-pox; but as in 
the large majority of cases it is a much milder affection, it is 
proper to give it a peculiar name. The following are the 
points in which varioloid usually differs from genuine small- 
pox. 1. The precursory symptoms are less violent and of 
shorter duration; and the whole course of the eruption is more 
promptly completed. 2. The pocks are less regular in the 
order of their appearance and in their distribution. 3. Vario- 
loid is not attended with secondary fever, or salivation; the 
swelling of the surface is inconsiderable or wanting, and the 
whole train of symptoms comparatively mild. 

Chicken-pox. A disease resembling in its essential parti- 
culars that which is now known to us as chicken-pox, has ex- 
isted, and been described ever since the dark ages; yet it is 
still disputed, whether the affection be distinct, or merely a 
variety of small pox, modified either by the constitution of 
the individual, or by the circumstance of a previous infection. 
The latter opinion has been ably maintained by two eminent 
European professors; but the former view is adopted by the 
great majority of medical authorities of the present day, and 
the arguments in its favour seem decidedly to preponderate. 
Chicken-pox has often prevailed, epidemically, over extensive 
portions of this country, without any material variation from 
a standard form, and without ever assuming the peculiar symp- 
tom of variolous disease. When observed, side by side, with 
small-pox in our cities, there is seldom any difficulty in dis- 
tinguishing them. The following description of the course 
of the disease, and the remarks which follow, will, we hope, 
place this important distinction in a clear light. 

Chicken-pox is sometimes, but not always, preceded by dis- 
tinct precursive fever, of the same general character with that 
which has been described, as announcing the approach of 
small-pox. On the third dav, the eruption appears in the 

*52 



410 cow-pox. 

form of small inflamed spots, commonly showing themselves, 
first, on the back and breast. These spots have little promi- 
nence, are of a pale red hue, and exhibit smooth and shining 
surfaces. In a few hours, a minute vesicle may be seen rising 
up in their centre, with a whitish, transparent, and extremely 
thin covering. On the second day of the eruption, the 
cles increase, and occupy nearly the whole of the inflamed 
spots, so as to resemble little bladders of fluid situated on 
narrow inflamed bases. Their form is irregular. They easily 
give way under pressure, and communicate to the finger a soft, 
elastic sensation, like pressure on a wet spo: _ mctured, 

the vesicles collapse and fall to the level of the skin. On the 
third day, the fluid becomes turbid, and by the fourth, many 
of the V( reak and form ( • contents of the 

others condensing and hardening within them. On the fifth 
day, most of I eir little pellicles 

collapsing, adhere to the* skin beneath, so as to confine a little 
fluid in the tubular ring which remains. The drying process 
On rapidly, and by the sixth day, all th con- 

con- 
tract into 8 tenth 
separate and a single piece, but in small 
ments, leaving ory traces in the skin. 'Die febrile 
symptoms, if any have been developed, decline on the second 
• f the eruption, and do not again recur. 

re, is equally distinguished from small- 
pox and varioloid. 

Cuu'-jjf.r. The iccine disease and cow-pox, both 

refer. II known, to the original source from which the 

infection cine 

matter has ever been obtained from the cow in this con 
and it has been found exlremt ly ilitlicult to procure it from 
the animal, even in those ; .and where it irai 

observed by. Whether bj . ous trat,^ 

sions it i ring the last fif 

has lost any thing of its prop! question not 

easily answered; but th ghl of opinion is decidedly a^ 

this view. The time required by the i compk 

course, and the successive appearai 

as can be ascertained, still the same as at the introduction of 
the disease, Though the anticipations entertained ot 
as affording a certain immuniu .all-pox, appear not to 

be fully realized, the exceptie: the ca> 

varioloid disease, which do not endanger life, are too r„ 
be regarded as very important. 

It is fully established, that vaccination is as s 
against small-pox, as this discr- n cither of its fa 



VACCINATION. 411 

Indeed, the results of strict investigation within a few years 
go to show, that the degree of protection is even greater. In 
regard to the other much agitated question, whether the effect 
of vaccination is permanent upon those on whom it is prac- 
tised, or whether, after a certain number of years, the suscep- 
tibility to small-pox returns, a difference of opinion still pre- 
vails. 

Experience seems to justify the idea, that in certain consti- 
tutions, a second vaccination will afford an immunity, which 
the first had failed to confer; but whether this depends on an 
originally unexhausted susceptibility, or is the effect of lime, 
it is not ( A large majority of the attempts at re- 

vaccination, which have been made, have failed in producing 
any specific effect; the puncture has exhibited .slight inflamma- 
tion for a few days, and then has entirely healed. This result has 
been manifested as clearly after an interval of thirty years, as 
at any shorter period. The idea, therefore, that the effect 
uniformly dies at the end of seven years, or any other definite 
period, seems wholly unsupported. On the other hand, in 
where revaccination appears to succeed, it may often be 
suspected that the progress of the former vaccination was im- 
perfect; a suspicion, for which the careless manner in which 
the operation is frequently performed affords abundant grounds. 
The strongest array of facts, in favor of revaccination, which 
is known to us, is contained in the Medico-Chirurgical Journal, 
for January, 18.34. [( that .statement be correct, it is conclu- 
sive in regard to the propriety of performing the operation 
under circumstances of peculiar exposure. 

The vaccine disease may be communicated either from a 
fresh vesicle during its progress, or by means of the dry crust 
which falls off, when the process is completed. The latter 
method is bv far the be*t for the domestic operation. 

The scab or crust, should be carefully preserved in waxed 
cloth, and when used, a small portion of it should be crushed 
or cut down to the state of fine powder, with the heel of a 
thumb lancet, then mixed with a drop of water, and rubbed 
into a paste. The surest mode of communicating the disease 
is this. With the heel of the thumb lancet, chafe the cuticle 
on the middle of the outside of the arm, till it is reddened over 
a space of half an inch. Then spread a portion of the paste 
upon the centre of this space. Then, with the point of the 
lancet, make half a dozen light scratches, close together, 
through the paste, and just deep enough to give a trace of 
blood, without causing a drop to flow; spread the remaining 
paste over the scratches, and let it dry there. About the third 
or fourth day, the germ of the future vesicle can be traced in 
an extremely minute pimple, scarcely prominent above the 



412 MEASLES. 

surface of the skin. On the fifth or sixth day, a little fluid is 
effused. On the seventh or eighth, the vesicle is perfect, with 
the upper surface depressed or cupped, and a red margin of a 
few lines in diameter. On the ninth and tenth, this margin 
spreads, the part becomes swollen, tense, and painful, the axil- 
lary glands are enlarged, and some restlessness and other evi- 
dences of general irritation are present. At this time, a rash, 
more or less general, often shows itself, principally observable 
on the chest and neck, and resembling that already described 
as appearing in small-pox. The v< - - con- 

cave surface, becomes flat, or convex, e size, and the 

contained fluid becomes opaque and viscid. On the eleventh 
and twelfth days, the areola begins to fade, sometimes from the 
external margin, but generally from an intermediate circ 
as to form a whiter zone, which can often be dm 
many hours. The swelling now rapidly diminishes, and the 
vesicle gradually dries. In the course of three or four days, 
the latter m converted ii b, which hardens becomes 

more and more p I distinct lrorn the surroui 

skin, and from tl h to the twenty-fourth dt 

either rubbed off I violence, or falls off of itself. 

The i B ;|ar: and anv 

material aberration, other than a mere delay in the first ap- 
pearance of the v. i!t doubtful. Vaccina- 
tion should never be performed during bad health, or the pro- 
a of another eruption. 

Mea$Ut, — This diseai bably always received bv con- 

tagion, that is. bj the touch, or n ach of some one 

already suffering under it. Measles n more common in winter 
and spring, than in summer and autumn; more frequent in 
children than in adults, but bj 

eumstnn or of Bl nuine measles seldom 

occurs more than once during life, and w hen judiciouslv bn 
is not often fatal. 

The commencing symptoms of mcmlm. which arc devel. 
from ten to fourteen (\a\ 
about the nostrils, with - 
cough, and. in general, the app 

set of a catarrh. The pre! -also indicated by 

the usual hot. dry skin, headach, tfc : the 

fourth day of fever, the eruption makes its appearand 
in deep-red, distinct pimples, which tainter and D 

confused as the disease advances, and collect in patches of 
irregular form, with intervals of i 
The febrile symptoms are not relieved, and - 
gravated. on the appearance of the rash. The headach 
fever abate in the morning to be renewed at night* and the 



SCARLET FEVER. 413 

hoarseness, cough, &c, continue without much abatement, as 
long as the eruption lasts. This begins to subside on the third 
or fourth day from its appearance ; the redness diminishing, 
and the skin assuming a mealy appearance, while scales are 
thrown off in the form of a fine dust. At this period, in 
favourable cases, the other symptoms subside; but sometimes 
the eyes continue tender and inflamed, and sometimes the 
cough remains. When the disease has been particularly 
severe* a torpid, lethargic state sometimes supervenes on the 
subsidence of the eruption: this is common also to scarlet 
fever, and will be noticed under that head. 

Active medical treatment is not usually required in measles. 
The eyes should be protected from the light; some laxative 
medicine administered; and the relief of the catarrh promoted 
by giving plenty of barley water and gruel, until the appe- 
tite returns. The body should be protected and the skin 
shielded from currents of air. The temperature of the drinks 
is not very important. The cough and difficulty of breathing 
may often be relieved by exposing the head, well covered, to 
the steam of warm water or of vinegar. U the cough be severe, 
and accompanied with pain, more active measures must be re- 
sorted to under the guidance of a physician. A moderate 
looseness occurring toward the close of the disease, is a source 
of relief, and must not be rashly interfered with. 

At the outset, measles are sometimes liable to be confound- 
ed with scarlet fever; but it is to be remembered, that in the 
last disease there is no sneezing, and no watering or swelling 
about the eyes, which in measles are always present. 

Scarlet Fever. For many years past, this disease has been 
regarded through most of the United States as the most dan- 
gerous and formidable affection of childhood. Where not 
immediately destructive to life, scarlet fever often prostrates 
the nervous power of the system, and lays the foundation for 
permanent debility. 

According to the views of many medical writers, scarlet 
fever and malignant sore throat, both often epidemic, and both 
specific, are yet to be regarded as distinct diseases; although 
it is allowed, that the latter is generally accompanied with a 
scarlet rash. For practical purposes, it is best to consider 
them as one and the same; keeping it in mind, that as scarlet 
fever, peculiarly so called, may occur, and even prevail epi- 
demically, without sore throat, so may the latter appear, ac- 
companied with a scarcely perceptible efflorescence. 

Scarlet fever, when epidemic, does not seem to be depen- 
dent for its production on contagion alone. When, however, 
this source can be traced, it appears to take effect in about 



414 SCARLET FEVER. 

three or four days. The eruption, which is nearly simulta- 
neous with the fever, consists at first of minute red points, 
soon confounded in a general blush, which extends itself over 
the whole surface, but is chieBy manifest on the face and 
breast. The colour of this blush is a bright scarlet, not seen 
in measles, nor in any other disease. On close examination, 
the small points of the skin will still be found inflamed, and 
slightly prominent; but the roughness thus produced has not 
the coarseness felt in measles. The appearance of a full and 
extensive efflorescence is a favourable sign; for the fuller the 
eruption, the milder will be the febrile symptoms, and the 
affection of the throat. The approach of the latter, which 
may occur as soon, or even sooner than the rash, is marked 
by a difficulty of swallowing, and sense of soreness. On exa- 
mination, the tonsils, and the neighbouring parts of the pas- 
sage are found swollen, and intensely red,' and, in a short 
time, patches of a white or ashy colour are observed, which 
indicate that ulceration of the mucous membrane has ah 
taken place. As the swelling and ulceration incre: * 
attempt to swallow is attended with much *j and fre- 

quently liquids taken into the mouth arc forced into the nos- 
trils. During this state of the part- differs no per- 
manent diminution and little n j the thirst is extreme, 
the skin hot, hcadach intense, the sleep broken by dreaming, 
Starlings, and twitchingi of the limbs; and not unfreqm 
delirium is present. Mean while the eruption, perhaps, after 
fading and reappearing, finally On the sixth or se- 
venth day of the fever, the whitish sloughs are loosened and 
thrown off, the ulcers heal, with relief to all the symptoms, 
and, in favourable cases, ti terminates from the - 
to the ninth day. When it is otherwise, death may take 
place from the violence of the fever at an early period, or the 
fever may pass into a typhoid th a sei mp- 
toms nearly resembling those which have been described 
under the head o\ continued fever, and which may run on for 
six or eight weeks, though usually with eventual recove: 

Scarlet fever is more frequent in children than adults, and, 
among the latter, in women than in men. [ti 1 and 

danger, however, both augment wit gene- 

ral, but once during life; but instances of a second attack are 
said to be more frequent than in : this sui 

however, testimony is not uniform. Dr. Lilian, of London, 
saw 2000 cases, only two of which were known to be of this 
character. 

In treating this disease, as its absolute arrest, by any means, 
is not to be expected, three objects are to be kep- 1 



MILIARY FEVER. 415 

To moderate the violence of the febrile action ; 2. To subdue 
those symptoms which immediately threaten life; 3. To coun- 
teract debility. 

For the first purpose, the principal agent which has been re- 
lied upon is cold, applied externally to the surface by sponging 
and bathing, and internally by the use of iced water and ice it- 
self. It has been even proposed to plunge the whole body, during 
the full development of the eruption, into cold water, and thus 
reduce at once the temperature of the surface: a violence 
scarcely to be justified by any circumstances whatever. Other 
means of moderating the fever are offered by the administra- 
tion of the neutral salts, and especially of nitre, which, when 
swallowed in substance in small portions, is thought to pro- 
duce a beneficial local action on the throat itself. The second 
object is to be answered, in cases where the inflammation and 
swelling are excessive, by general bleeding, and the abstraction 
of blood from the neck by leeches. The third is perhaps the 
most important, as the stage of debility soon arrives, and the 
condition of the system which accompanies it must be prompt- 
ly met. As soon then as the active fever subsides, if a state 
of languor, prostration, and debility succeed; if the tongue re- 
main loaded, the bowels torpid, and the spirits depressed: espe- 
cially if the ulcers refuse to heal and assume a foul and un- 
healthy aspect, no time is to be lost; bark, wine, and the acids 
must be given internally, gargles of the same character em- 
ployed for the throat, and every means resorted to, for pre- 
venting irritation of the digestive system, and supplying it 
with mild nourishment. The typhoid state, to which we have 
alluded as a sequel common to this disease and to measles, is 
peculiarly protracted and obstinate in children. Sometimes 
such a degree of debility is induced that the articulation is 
wholly lost, the limbs are perfectly paralyzed, and the mental 
powers prostrated. In this state it is through the stomach, an 
organ only a little less weakened than the others, that these 
are to be slowly re-established. The patience, perseverance, 
and care, necessary for the task, can only be realized by one 
to whom the charge has been committed. From day to day 
the same discouragements are renewed, and it is only after 
weeks of patient and assiduous labour that hope seems to 
dawn, and the efforts of affection and duty once more promise 
to be crowned with success. 

Miliary Fever or Sweat Ervption. The name of this 
disease sufficiently explains its origin. It occurs in persons 
of loose fibre and indolent habits, who have been keeping up 
a profuse discharge from the skin for several days by lying in 
bed in warm apartments, and covered with too much clothing. 
Women are more liable to it than men, and it occurs very fre- 



416 NETTLE-RASH. 

quently in child-bed — when the system is already weakened, 
and the constant use of warm diluent drinks often increase 
the excessive sweating. 

It usually appears in minute red points much like those seen 
in the commencement of measles, being most numerous on 
whatever part of the body has been kept warmest. The sweat 
which accompanies it is frequently of offensive odour; it is 
principally troublesome by itching and tingling, and is at- 
tended with thirst, heat of skin, and often a coated and foul 
tongue. The period of its duration depends on (he continu- 
ance of the causes which produced it. If external heat and 
internal stimulants be continued, lest the eruption should be 
driven in, the latter may be kept up indefinitely; but if the 
clothing be diminished, the surface exposed in a reasonable 
measure to the air, hot drinks avoided, and the surface sponged 
occasionally with cool water, particularly if to these means be 
added a gentle saline cathartic, the disease subsides in a few 
days. 

A form of this complaint, better entitled to the appellation 
of erupt i \ is mentioned by authors as occasionally epi- 

demic. The fever pn j about tl.. 

the disease runs on, with variable remissions, for seven, four- 
teen, or even twenty-one days, and usually terminates in a na- 
tural sweat. It hti lometii < d fatal. 

Nettle-ra.sh. — Nettle-rash is characterized by the appear- 
ance of wheals, or bl florid elevations of the skin, 
accompanied with itching and tingling, appearing sur 
in different parts, and fading Sbd reviving very irregularly. 
Its most frequent remote cause is the presence in the stomach 
of food, either poisonous in itself, or disagreeing with the 
constitution of the patient. Such are cucun >hrooms, 
crabs, shrimps, herring, muscles, some kinds of honey, mack- 
erel, and oysters at particular - iwberriei 
have been known to produce it, and, much more frequently, 
fresh pot s ome of the mineral substances, as 
also copaiba and pnissic aeid, have the same power in some 

It sometimes occurs as an en, J in by a re- 

gular chill, and the eruptii If on the second day. 

In the dyspeptic form of the affection, the removal of tl 
fending matter usually affords relief; though sometimes it con- 
tinues obstinate for several days. In the febrile variety little 
medical treatment is needed. A cooling aperient may be 
given, and vinegar or brandy may be applied to the skin for 
the relief of the itching. In sonu j been 

found necessary; and in others, a few grains of super-carbo- 
nate of soda are found very useful occasionally. The disease 



PRICKLY HEAT, OR LICHEN SHINGLES. 417 

appears to become chronic in certain cases; but these will be 
found to depend upon some continued error of diet, which 
corrected, the eruption will disappear. 

Prickly Heal or Lichen is a disease caused by intense and 
long continued heat; but it may be excited by the same causes 
which produce the nettle-rash, when the system is prepared 
for it. It is one of the most annoying plagues of a tropical 
climate. The general character of the disease is that of "a 
diffuse eruption, with red pimples, and a troublesome sense of 
tingling or pricking." There is more or less general irrita- 
tion, and sometimes a little fever at the commencement. In 
its milder form, it first appears with distinct red papillae about 
the cheeks and chin, or on the arms, with little inflammation 
around their base. In the course of three or four days, the 
eruption spreads over the neck, body, and lower extremities, 
producing an unpleasant sensation of itching, often aggravated 
at meals and during the night. In a week or ten days, the co- 
lour of the eruption fades, and the cuticle separates in scurf. 
This is the common form; but we find that from external heat, 
and sometimes from internal disorder, a vivid rash is often 
thrown out, consisting principally of deep red pimples, occa- 
sionally degenerating into wheals like those of the nettle rash, 
which remain for a considerable time, unless the atmospheric 
or other causes are removed. For the relief of the itching 
and burning sensation attendant on prickly heat, which in tro- 
pical countries are often absolutely intolerable, the best appli- 
cations are brandy and cold water; the latter requiring some 
caution when the patient is perspiring. 

The slightest stimulant either in food or drink, will often 
diive the new-comer in Bengal, from the dinner table to the 
bath, much to the amusement of the company. 

We have even seen life endangered in Calcutta, by the ex- 
cessive irritation in Lichen, which sometimes renders the 
whole surface of the person thick and hard, like some leprous 
affections; but this state always results from gross indulgence 
in food or drink, and soon moderates on its discontinuance. 

Shingles are sometimes, but not generally, preceded by some 
constitutional affection, as sickness and headach. The first 
local symptoms perceived, are itching and tingling in some 
part of the trunk, which, when examined, is found to be stud- 
ded with small red patches of an irregular shape, at a little dis- 
tance from each other, on each of which numerous minute 
elevations are seen clustering together. These are easily per- 
ceived to be vesicular in their character. In the course of 
twenty-four hours they enlarge to the size of small pearls, per- 
fectly transparent, and containing a limpid fluid. The clusters 
are of various diameters, from one or two and even three 

53 



418 RINGWORM — ITCH. 

inches, and are surrounded by a narrow red margin. For three 
or four days, other clusters continue to arise with considerable 
regularity, nearly in a line with the first, extending always 
Cowards the spine atone extremity, and toward the breast-bone 
or median line of the belly at the oilier, till they form a half 
circle. Sometimes the disease nearly, but never entirely 
circles the neck, arm or knee. Instances of its takii 
tudinal direction, are very rare. In five or - . the fluid 

of the rest ume a pearl-like colour and becomes W 

purulent. If the inflammation be unu ■ •re, it 

D6 actually converted into pus. Between the second 
fourth days, some of the w 
charge a limpid fluid The cu -hod, and the 

■ tin bid fluid. Others shrink Dp 

transi A in- 
flamed surface. 

The causes of t es are r ood, 

it shows Usell <>r the I at of 

autumn, and freqv >a un- 

wholi some diet, and other causes <-i debility. As respects i 

little i 

Ringworm is an afli ngles in som- 

I, but is much llightei , 

circular, — \\h- 

the margin of the ■ 

and disposed to peel off in bl A single circular 

patch often runs throw eeks; 

but a nev i up in ourhood, and so on iu 

sin cession for an indi I 

s as solutions 
of lead, white vitii re in use, as is 

wise, laudanum, diluted with an equal or larger quantity of 
wal« 

Ink, which - (her 

by its arid or Iu gen Its do 

not answer, but ■ es an immediate cure. 

Attention to e!ea: ! the 

spots may be washed to any extent with soap and m 
Ringworm has sometii 1 to be c 

account is now b tance in w 

affected with the disease, communicated it in a tx>arding-»c 
SO that fourteen out o! en pu| ih y at- 

tacked. 

77k- tich haa aflammat 

without fever, consisting g a serous 

fluid, which may appeal but are I 



ITCH — ROSE RASH. 419 

principally in the flexures of the joints, and between the fin- 
gers and toes." In the severer cases, and later stages of the 
«'i flection, the vesicles degenerate into pustules, containing a 
yellow matter, and these, sometimes coalescing, form irregular 
and unsightly blotches. Itch may spontaneously arise from 
filthy and negligent habits; but it is usually received by conta- 
gion. Adults take the disease less readily, and when contracted 
by them, it remains dormant for a longer time. 

Itch, at its first appearance, is sometimes difficult to distin- 
guish from other eruptions; but when it has become confirmed, 
the coexistence of the pimple, the vesicle, the pustule, and 
the scab, the absence of fever, the close aggregation of the 
eruption in the particular parts already mentioned, and the 
circumstances under which it shows itself, are sufficient to 
determine its nature. 

Many intelligent writers assert, that the proximate cause of 
itch is a peculiar insect, which is often found in the pustules; 
but the necessary connexion between the disease and the ani- 
mal is not sufficiently supported by evidence. 

When itch has continued for a long time, and extended it- 
self to the surface, generally, its sudden removal by treatment 
has been said to produce internal disease, and even mental de- 
rangement. But, as a general rule, no hesitation should be 
felt in curing it by the speediest possible method; for it is 
never known to cease spontaneously. In the treatment, va- 
applications have been employed with nearly equal sue- 
since it seems sufficient to induce a new action in the 
part by some active stimulus. Thus sulphur, zinc, mercury, 
lum t tobacco, and tar, can each boast of its cures, 
and preparations, dependent on one or more of them for their 
virtu. t different times, enjoyed the reputation of spe- 

cifies. The common mode of employing sulphur, is to pre- 
pare an ointment of this article with lard, and rub it well into 
the affected parts, for two or three successive nights, before a 
warm lire; after which the skin must be thoroughly washed, 
usual to administer the sulphur, internally, in slightly 
laxative doses; — an innocent treatment, and one which may 
prevent a repulsion of the disease from the skin. A neater 
mode of employing the same stimulant, is the use of a sulphur 
bath, the patient being enclosed in a box, so that his face only 
is exposed to the external air, and the fumes of the sulphur 
being admitted from below. Other ointments and lotions for 
the itch are in common use; but it is needless to describe 
them. 

The rose rash appears in a blush, similar to that which 
belongs to the specific febrile eruptions. It has been mistaken, 



420 GUM RASH — PRURIGINOTS RASH. 

in fact, for scarlet fever, from which it differs in this circunv 
stance, that the redness is removed by slight pressure, and re- 
turns at once over the whole part pressed upon, when the 
pressure is removed; whereas, in scarlet fei return of 

redness is more gradual, and extends from the circumference 
toward the centre. The resemblance, however, is such that 
children have been supposed to have scarlet 
times in succession; an error, which attention to the above 
mentioned circumstance, and to the slightness of the general 
affection, will be sufficient to prevent. R fre- 

quently occurs daring the first dentition, especially v 
acid is present in the stomach, and it d th the re- 

moval of the irritation by which it was occn> In adults, 

y occur during the heat of summer, somewhat in the 
manner of lichen, and run a 1 | three or four 

. then dtsapp ontaneously. It sometimes I 

tn annular or ring like form, with a wh in the centre. 

ill, but l • dilate to the dia- 

i of htlf an i 

The gum rath ii i baraetari ivid minute 

pimp! kly set upon a surface of a I colour. 

Sometinv 'he pimples are whitish, and hence the 

distinction ofwhil 1 gum. -case, in one of its 

i If in in t thin two or three daj 

birth. In another, it appears like th- >ing; 

and again, occasionally :i ovcr-hcati: . _ 

or disturbs nee of the stomach. W. -rash 

is always Attended with considerable itching, and is aggra- 
1 by excess in clothing and warmth. 

itching, and 

nn eruption of pimples nearly of the colour of t! i hich 

concrete into bJsel t, the 

; and it is frequently imi mcleanly 

habits, conjoined with reoiden imp, unhealt: 

. and 
the itching is incf lien clothing, 

&c. Prom scratching, "rition, the pimples sometimes 

degenerate into small ich keep up 

indefinite period, ami may resemble A f the 

itch. 

There are numerous, we might almost say numberless, other 
cutaneous diseases, upon f e could OCCU] 

ble space; but, are for the most | with 

difficulty} as they are often extremely unmanage.. . more 

especially, because none o( th- 
treatment, we prefer omitting them in a p 



ERYSIPELAS. 421 

signed merely to assist the intelligent "who are not of the pro- 
fession in their endeavours to be safely serviceable, and not to 
supply the place of the physician when accessible. 

, \Y r e will now pass to the consideration of some very serious 
affections, a few of which properly belong to the eruptive fe- 
vers; but which we have thrown into a separate section in or- 
der to preserve their connexion with some othei diseases , with 
which they are often involved in intimate complication. 



x in. 



Erysipelatous Affections. 

ysipelai is an eruptive fever of a typhoid character, oc- 
curring more frequently in persons in advanced life, or those 
of debilitated constitutions, but confined to no age or condi- 
tion. It often breaks out, as a limited epidemic, in hospitals, 
jails, &C 

Its approach is insidious, the preceding fevi-r being often 

lllght Sometim is chill, succeeded by heat, and 

itpanied by drowsiness and even by delirium. On 
the third and fourth day I redness shows itself in some part 
of the person. At first, this is not very distinct, and the line 
which separates it from the surrounding parts not very well 
marked; but ii gradually spreads in all directions, and as it ad- 
vances, becomes more prominent, and its outline more per- 
fectly defined. When it attacks the face, the nostrils become 
Swollen, tense, and painful, and the eyelids so much enlarged, 
as often entirely to obstruct the sight. In the majority of 
cases, perhaps only one side is affected; and then the bounda- 
ry may be traced along tbe ridge of the nose, bisecting the 

the chin, and the scalp. The distortion of the features, 

idly of the mouth, is among the most striking appear- 
On examination with the hand, the morbid action is 
found to involve at least the whole thickness of the true skin, 
to which it imparts an unnatural hardness and a peculiar fleshy 
feel. At first, slight pressure causes the colour to disappear, 
which returns when this is removed. The parts first attacked, 
and the others in succession, begin to form blisters in irregu- 
lar patches on the second or third day. The fluid effused is 
yellowish or livid, and oozes out through small crevices. On 
parts where blisters do not appear, the skin usually dries into 
line scales, like those seen at the close of measles. The in- 
flammation and accompanying fever usually continue from eight 



422 POISONED WOUNDS. 

to twelve clays. During this time, however, the eruption trails 
along gradually and successively over different parts, so that 
the process in a given part is completed in somewhat less time: 
at length the disposition to spread nd the disease sub- 

sides. The signs which indicate danger in this disease are the 
continuance or renewal of the delirium, and the occurrence of 
coma or torpidity from which the patient is with difficulty 
roused. These, however, do not necessarily indicate a fatal 
termination; for persons in advanced life often exhibit both 
delirium and coma for mil 

The treatment must vary with the condition of the patient. 
If he be accustomed to drinking or improper food, if nausea 
and dyspeptic hetdsch be | particularly if accompanied 

with i the mouth, an emetic is proper, and should 

not be withheld l> ir of tendency to the head. One or 

two cooling and moderate >metimes needed; 

but, iu general, ill very active evacuations are improper. 
When there il n Itration, the decoction of Peruvian 

bark. ition of quinine, may be given in such quantities 

as the h will bear. \.l Eternal applications, great re- 

\>y dusting the part with meal, and 

ntly have a happy effect. The 
lution of opium, so usefol . »f other parts, 

is inadmissible in that of the face. The mucilaginous washes 
seldom benefi have always found the much 

lauded unctuous prep Iccidcdly injurious. In t 

pelas which is advancing unli rapidity slong 
its J" I by a narrow blister ap- 

plied surround the limb, over the line where the in- 

flammation term i i 

The erysipelas of infants is i peculiar disease, which 

show - ithin B few I ;rth; 

in fact, it IS someti l I tal. It commences ordinarily 

about the navel, and in its | lower part of 

the sbdomen, the hip, uion fol- 

i of the parts; but in in- 
fants at the period just alluded to. the disease may prove fatal 
without reaching either of the- 

1 iOCsl I from wounds may occur on any part of the 

body, but most frequently follows on wounds of the scalp, and 
then assumes much of the character of general erysipelas, as 
already given. 

toned Wo*nd$, — Erysip i, urn- 

stances, is connected directly with tl 
and not with the local injury on which it fa 
grafted ; but in poisoned WOU1 
toms depending 00 the poison itself is introdu • 



POISONED WOUNDS. 423 

of specific virus introduced by inoculation do, indeed, engen- 
der diseases wholly different from erysipelas; but, at present, 
our attention is due to poisoned wounds, from which diffused 
inflammation of an erysipelatous character usually results. 

The most familiar instances of poisoned wounds, arc those 
inflicted by insects, such as the wasp, the hornet, the bee, the 
musquito, the field-spider, Sic. All these have the power of 
inserting into the wound some peculiar fluid, capable of pro- 
ducing a specific effect. In the bee, this poison lies in a small 
bladder, situated at the base of the sting. When the bladder 
has been removed, the wound produces no more effect than a 
simple puncture. The poison flows from the vehicle through 
the sting, which is tubular, at the moment when it is inserted; 
and the mechanism in all other venomous animals is nearly 
the same. Generally, a sting by any of the smaller insects 
produces an inflammatory swelling, which subsides of itself; 
but this i' 1 part, depends on the location of the wound. If the 
eye be stung, for example. wrv serious consequences may 
ensue. In constitutions of peculiar susceptibility, almost any 
of these stings may produce danger, and even death; in- 
stances being on record of the latter result, from the bites of 
spiders, and the -tin-j^ of wasps and musquitoes. Death has 
followed m iev< es within half an hour after the infliction 

of stings bv 8U)gl< 

The treatment most Btrongly recommended is, first, if the 
be in the wound, carefully to cut oil' the poison vesicle 
from: then to extract the former; Dext to immerse the 
part in wry cold water, and Lastly to cover it with cloths 
soaked in lead-watl r, or rub it with oil, |><>|>py juice, or brine. 
If the inflammation i- i . local and general 

bleeding must ployed. We believe, at last, that the 

best local application i* the childish one of coin wet mud. 

The most severe' poisoned wounds are inflicted by the sco- 
lopendra, the scorpion, the viper, the cobra di capello, and 
the rattle-snake The mechanism by which the wound is in- 
flicted, is much alike in all. The tooth itself is perforated by 
a cavity through which the venom flows. The bite or sting 
of these animals is followed by local pain, swelling, redness, 
and a rapid disorganization and effusion of the blood. These 
effects extend to the whole limb, and not unfrequently to the 
trunk of the body also. After a time, the pain abates, the 
part becomes soft and cold, and mortification supervenes. 
The general symptoms, in these severe cases, are prostration, 
anxiety, difficulty of breathing, and profuse sweats. 

In the advanced stages the skin is cold; the pulsation of the 
heart scarcely perceptible; the stomach incapable of retaining 
liquid; and delirium soon supervenes. The bites of venomous 



424 POISONED WOUNDS. 

snakes, however, are very unequal in their consequences, their 
malignancy being greatly influenced by the state of the poi- 
son vesicle at the time, the part bitten, the constitution of the 
sufferer, the season, &c: many persons escape with trifling 
inconvenience, while, in others, death may take place in a few 
hours. 

In the treatment of the bites of poisonous reptiles, a great 
variety of nostrums have been recommended. Absoi 
magi, . the bruised leaves of several of our indige- 

nous vegetables, certain roots used to deceive the \ 
those arch rogues the snake-catcher . have 

highly extolled ai the bite of the rattle-snake 

and cobra di eapcllo. 

We li ivc apenl n iich time in - tion of the claims 

of these articles on the theatre of their employment, and are 
firmly convinced of their Do ibtlessly the 

claima of the I plant which I .tl'y obtained high 

fame on South A mtiican authority. Will 
founded, but we have not witness! 

about the wound, arc mot lible rem 

sorption o ling of the poison is so rapid, ti 

be il i icyond i 

of the remedy in w minutes, ami the means for sale* 

rforming the operations | r ob- 

tainable so soon. 

The popular method of applj Mind tho 

limb aOO?e the swelling) i* at war will: e\ - i y principle of good 

surgery and common directions will I 

from tlie well trie gent American n 

men, and illy thrown on the hi>tory of ab- 
sorption. 

Dr. Caspar Pennock, of Philadelphia, has discovered that 

wire on a partieulaj ttly firm to i 

the circulation in the ; tually delays the absorption of 

a poison until the prest ; and, in the wounds 

under consideration, it is well known that the blood vi 

which have fell the full action of the 

OUt tlu 4 vitiated blood from the 

it to flow into the cellular tissue through tl ll ' 

seen the arm-pit full ol of a 

rattle-snake on the point of the , — and the groin in the 

same situation, from I ^reat toe. 

When a patient, then, is bitten at a 
let him instantly seek a pebble or a hard chi 
able size to make pressure on an inch o: 
the wound, and let him bind it exactly on the part, with great 



ERYSIPELAS PHLEGMONODES. 425 

tightness, with his handkerchief or the sleeve of his shirt, 
twisted, if necessary, with a stick, as directed in the remarks 
on the tourniquet in the section on incised wounds. If bitten 
on the finger or toe, let him arrest the circulation at once by 
ligature. Time will then be allowed for farther action. 

No woodsman or traveller should be found without his tin 
or glass flask for drink, and his means for making a fire. If 
the former happen to contain a little whisky, it will be for- 
tunate. 

The next step is to light a fire, and heat the flask with a 
little liquor or water in it till the fluid boils. Then, quickly 
removing the pebble or chip, let the flask be emptied at once, 
but without agitation, and, while full of steam, invent it with 
its narrow neck over the wound. As it cools, it produces 
powerful suction, and the greater part of the poison, together 
with much of the vitiated blood, will be drawn into the flask. 
This plan will be found inapplicable in wounds of the lingers 
and toes; and here some good might be done by suction with 
the mouth, if the teeth and gums of the operator be in per- 
fect order; but we would prefer amputation above the liga- 
ture, to the dangers of such an experiment. 

We firmly believe that suction and amputation are the only 
local resources in these accidents. The former does not re- 
move the poison entirely, and the system has still a struggle 
to go through, but one in which it always conquers, if the 
;ion be rightly performed. If the means of suction 
are not obtainable on the spot, the patient must depend on 
ne till he arrives at a house. The rattle-snake 
bite is rarely fatal to stout adults, except in very warm wea- 
ther, and the stings of scolopendrai and scorpions seldom ter- 
minate in death. 

The general treatment of these accidents should be such as 
is adapted to typhoid fever, combined with that of erysi- 
pelas. 

Erysipelas Phlegmojiodcs, or Diffused Inflammation of 
the Cellular Tissue. When erysipelas becomes epidemic, 
there is a strong tendency in all wounds and local injuries, 
whether caused by operations or accidents, to take on a pecu- 
liar form of the disease which is not confined to the skin, but 
extends deeply into the cellular tissue of the limb or part af- 
fected, involving, in many cases, even the fasciae, and al- 
lowing nothing to escape, except the principal vessels, the 
nerves with their sheaths, and the muscles. This inflamma- 
tion commences at the wound, pursues the usual course of ery- 
sipelas, so far as the skin is concerned, and is attended with a 
typhoid fever, in which the symptoms in the head are much 

54 






426 INFLAMED VEINS AND ABSORBENTS. 

less marked than In erysipelas of the face, delirium seldom 
appearing until toward the last, in fatal cases. 

The cellular membrane, in the mean time, passes on to sup- 
jxiration, without much pain, and as nature makes no attempt 
to circumscribe the pus, or form a regular abscess, except, 
perhaps, an imperfect and inefficient one whenever the dis- 
ease in its regular progress approaches any one of the princi- 
pal joints, the matter flows unrestrained through the cells of 
the cellular tissue, which soon mortifies most extensively, 
causing the part to feel doughy, or like a quagmire. The 
skin, retaining its vitality, ulcerates into rounded orifices here 
and there, to give exit to the pus and the sloughs of the cellu- 
lar tissue, which may often be pulled out in masses like wet 
tow many inches in length! After a time, if the pus be care- 
fully pressed out, we may often look down through these 
holes upon the muscles and great blood vessels of the limb, 
dissected clean by the mortification of the tissue! Yet even 
this horrible disease, when properly and carefully treated, 
will generally yield to medicine; and the patient then reco- 
vers without permanent deformity — the cellular tissue being 
regenerated ! 

Surgeons have it in their power to limit very much the 
progress and danger of this disease, by making long incisions 
through the skin at the time that the pus begins to form, but few 
patients will submit to the remedy. When necessary, the holes 
in the skin should be freely enlarged, to give exit to the pus 
and sloughs, and as the spreading of the matter is the chief 
cause of the mortification, great care should be taken to fix the 
part in such a position as to drain off the fluids, and to apply 
light bandages above and below the inflamed portion of the 
skin, to prevent the pus from percolating farther. In other 
respects, the local treatment resembles that of common erysi- 
pelas; the watery solution of opium being one of the best ap- 
plications, and poultices of all kinds being inadmissible. 

The general treatment is similar to that required in typhoid 
fever, and exhausting discharges of pus; but an occasional ad- 
dition of five grains of calomel will be found highly servicea- 
ble in correcting torpidity of the liver, which is almost always 
present. The violence of the disease is generally over, in 
from fourteen to eighteen days, but the discharge and debility 
may last for months. 

Inflammation of the J~cins ami Absorbents. After b! 
punctures, burns, bleeding, pricks from the knife in dissection, 
&c. on the upper extremities, wc sometimes see considerable 
erysipelatous inflammation about the wound, followed, in a 
few days, by burning pain extending to the elbow or arm-pit 
— and long red lines running from near the wound tow 



INFLAMED VEINS AND ABSORBENTS. .427 

the same parts. If the disease continue, the glands of the arm- 
pit swell and become extremely sore; and when the red lines, 
which are thickened, hard, inflamed, and exquisitely tender, 
have reached the elbow, or, if commencing there, the shoulder, 
a violent and most dangerous irritative fever supervenes. At 
each joint reached by the inflammation, which is chiefly 
seated in the absorbent vessels or the veins, diffuse inflamma- 
tion of the cellular membrane and more or less erysipelas ap- 
pear. An attempt is then made to arrest the disease by the 
formation of an abscess; but this is rarely effected except at 
the arm-pit. The abscess, if formed, is not limited; and after 
passing the shoulder the pus is seldom checked in percolating 
the cellular tissue, till it reaches the middle line of the body — 
as in common erj^sipelas. 

The great object in the local treatment of these often terri- 
ble cases, is to bring about resolution, and prevent the forma- 
tion of pus. Of course, no unprofessional man would have 
the rashness to tamper with a disease of this character which 
frequently terminates mortally in from five to fourteen days, 
unless in situations where it is quite impossible to obtain me- 
dical advice. To meet such exigencies, however, we will 
venture upon a few remarks. 

If the patient be not too much debilitated by intemperance 
or previous disease, the lancet may be used, with caution, at 
the onset of the fever. A bread and milk poultice, dusted 
with opium, must be applied immediately to the wounds. If 
leeches be procurable, they may be employed freely over the 
inflamed lines, carefully avoiding the neighbourhood of the 
erysipelatous blush about the joints. If cold applications be 
agreeable, use them to the same parts with the same caution. 
After these measures, and such general treatment as is adapted 
to continued fever, (see the appropriate subsection,) have, in 
some degree, diminished the pain, apply a blister over the 
termination of the red lines, including the bend of the neigh- 
bouring joint. If, notwithstanding these efforts, there is evi- 
dence of erysipelatous inflammation of the arm-pit and side, 
and a threatening of abscess there — the case will probably 
terminate mortally, in the absence of an experienced surgeon. 
If the patient survive till pus is fairly formed, open the ab- 
scess early and freely, and endeavour to prevent the subsi- 
dence of the pus toward the hip, or back, by compresses or 
suitable bandaging. At this stage, the fever is decidedly ty- 
phoid, and the exhaustion from the enormous discharge is 
terrible. We cannot do better than refer the reader to the 
latter part of the subsection on continued fever, and on the ter- 
mination of inflammation in suppuration, for the little light 
which can be thrown upon the general treatment in addressing 
those who are not of the profession. 



428 CATABRH. 



SECTION IV. 



Diseases of the Respiratory Apparatus. 

Catarrh. The symptoms of a common cold are too well known 
to require any description. Its usual causes are a sudden 
change of temperature, partial exposure to strong dr 
air, or to a cool and damp atmo- at it often makes its at- 

tack without obvious reason. In its nature it is a mild d< 
of inflammation, generally commencing in the mucous mem- 
brane of the nose, and ivities, and gradually 
extending through the mm be larynx, and often to the 
whole length of the ail Its tendency is to produce 
superficial fffiltlMH, or an cretion of 
the natural mucus. When confined chiefly to the larynx, 

I scarcely sufficient to pro- 
duce much febrile reaction; but when tl or a coi 
rable part of the air pas>agcs are involved, it makes up b 
tent for its deficiency ta violence, and tfr ea y m p t o m a n V 
often quite severe. 

Still, in ttarrfa m ?ery rarely 

becoming so, only in i nee of its forth 

any latent tendency to other Beiioc ons, such as con- 

sumption, scrofula. 

In one form catarrh becomes epidemic, an- imc, 

of influenza. I progre ss ef the I 

ral great infiu ant doom i 

i< B matter of great interest, but our limits compel us to omit it: 
suffice it ' 
rapid to be caused by conti -1 both its 



r; ■ 



the impossibilit D attack 

care, disprove its de| • icric 

lure or moisture. Though these 
nary causes o\ catarrh m 
its \ iolence, the source oi infliH 
terious agents which probably produce all ll, 
domic disease. Influenza probablj than 

the plague, though secretly; for it calls into action all lurking 
tendencies to consumption, scrofula, and other chronic diseases* 
and while apparently immolating lew victims itself, it obviously 
swells the bills of mortality through the ag asea, 

tor one or two years al 

There is a peculiar form . rh, the obstii 

o( which depends upon a dysj 



TREATMENT OP CATARRH. 429 

It yields only to the remedies appropriate in that complaint. 
There is also another, peculiar to elderly people, being an ha- 
bitual cough, accompanied with loose expectoration, occasional 
hoarseness, and increased secretion in the nose and fauces. 
This, it is considered dangerous to cure, but it is much relieved 
by a course of stimulating treatment, the reverse of that which 
is employed in a common cold. 

In common catarrh, active or severe remedies are seldom 
needed. It is a common impression that a hot beverage taken 
at the outset of a cold, aided by rest in a warm bed, will bring 
on perspiration, and cure the cold. In all mild cases, the first 
of these effects will generally follow, and as no evil can result 
from the trial when there is scarcely any fever, the plan appears 
worthy of a trial. It is indeed natural to suppose that as sup- 
pressed perspiration often causes the disease, restored perspira- 
tion should relieve it; and the rule is found true to a certain ex- 
tent. If the first intimation of approaching catarrh — the first 
tickling sensation in the nostrils — were to be met by increased 
protection of the person, a draught of hot mint, or other mild 
tea, or even a brisk walk, the disease might be successfully 
combated in many cases. But nature is not to be interrupted 
in her processes at all times, or under all circumstances; and, 
having adopted a particular mode of counteracting a morbid im- 
on, she cannot be expected to abandon this, at an advanced 
stage, for one offered by art. Hence, our sudorifics often fail 
in producing the defiled ellect. In respect to the more simple 
articles employed in this way, being always harmless, their 
failure need not be dread 

But of the stimulating compounds prepared with brandy, 
or other alcoholic ingredients, this is far from being true. 
They may not only fail in curing, but may aggravate the malady. 

Hot lemonade, or some simple infusion, therefore, will be 
found a far safer remedy. There is reason to doubt whether 
the production of a sweat depends very materially on the heat 
of the beverage. When the body is well protected externally, 
cold drinks excite the surface as readily, and, when there is 
much fever, more readily than such as are warm. In the far 
west, where the processes of the healing art are conducted 
somewhat summarily, we have been told that it is common to 
cure a cold by covering the body with buffalo-skins, placing 
the feet opposite a good fire, and causing the patient to drink 
cold water. There is much good sense in the plan, and it can 
hardly fail to prove salutary. One of the best and most 
powerful sudorifics, after fever has supervened in bad colds, is 
a weak, hot infusion of bone-set (Eupatorium perfoliatum.) A 
full pint should be drank at bed-time, and as hot as possible. 



430 INFLUENZA. 

There is, usually, even in cases of a mild character, a per- 
ceptible aggravation of the symptoms toward evening, marked 
by a slight creeping and chilliness, which sufficiently indicates 
the propriety of caution in regard to exposure at that period of 
the day. If the fever run hi^h, the depletory com- 

mended in the commencement of the continued fever, come into 
play, and as a febrifuge, ten drops of antimonial wine, with 
thirty drops of sweel of nitre, ma; 

two hours. Inflammations of toe throat, wbi supervene, 

may be treated like other inflammation! wh< 
sired, but cold application- iina- 

lions of In fla mm>> 

Parents oft. er it necessary to keep their children at 

home from school and play (it ma; r inclina- 

nation) f< too trivial to uention, and 

which are rather aggravat ved by t! ;tion. 

: 

ficial, as w< li m an 

atmosphere heated and dried by a glou of anthracite 

coal. 

Ini inflammation 

of t Ik , all tin* a sex- 

the subs! 
in addition to t h« and 

Wheezing, .1 rapid pu 

headach. Tin - usually r« gular ^me- 

times asaumes an ir intermittent type In 1 

ticular epidemics, many \ sank int<> collapi 

w boors : and the disea* 
cramp, most painful cough, « 1 num. 

But, m fact, the 1 lemk, like all o4 

rably al 
times very mortal anion:: the robust; but if the 1 cate 

succumb, it i- - ases 

< ni:< ndered bj the complaint \\ 
pe with a lighter par 

Aj the nature of tOH 

men catarrh, and a lung fever, the application oi a li;t!> 
cretion ami intelligence, to the practical 

these heads, will - ,ule in ti 

than any mlcs which could be given & 

For the relief of cough in the rrh.when 

mild, any of the lozenges which taudaausn or 

opium in the crude state, may , the 

chronic forms and la t .. when 1 

lozenges and the brown mixture are useful. In the catarrh 



PLEURISY. 431 

of old men, the following expectorant mixture has been found 
to give much ease. 

Gum ammoniac, - one drachm, 

Gum Arabic, .... half an ounce, 

Antimonial wine, - one drachm, 

Hartshorne's acetic tincture of opium, one drachm, 

Pure water, six ounces. 

Rub these ingredients together in a mortar, until they form 
a milky mixture. 

Dose. — A table spoonful three times a day. The sirup of 
squills, in table spoonful doses, occasionally, b also serviceable 
in protracted cases among adults; but we think it increases 
the susceptibility to disease of the throat in voung persons. 

wrisy. — An attack of pleurisy is marked by acute pain in 
some part of the chest, most generally referred to that part of the 
side which corresponds to the sixth or seventh rib, about mid- 
way of its length. The pain is sometimes heavy and dull, 
some: tt< ■; but always aggravated by a full breath, 

which, therefore, the sufferer mot carefully avoids. When a 
full breath is taken, it induces cough, which, for the most 
is short and dry. The ordinary breathing is unaccompanied 
with or pain, at least, until the distention of the 

chest arrives at a certain point. The pulse is hard and fre- 
quent, but the other symptoms of lever are not generally very 
strongly marked. 

It is certain that a disease attended with these symptoms 
often exist-, and is relieved promptly by a full bleeding, or 
finds spontaneous reli nallv in sweating; and it is 

dingly probable, if not quite certain, that the seat of 
i these cases, is the pleura or investing membrane of 
That we have not more direct evidence on this 
point, arises from the fact, that these symptoms admit of 
lief, and rarely prove fatal, unless accompanied by 
others which mark affections of the substance of the lungs. 
Doubt has been thrown on this subject by the circumstance, 
that when lung fever, which have never exhibited these 

symptoms of pleurisy, have proved fatal, the pleura has been 
found, on examination, to participate in the disease. Effusion 
into the cavity has been discovered, and in many instances 
the two sides which form the cavity have been found adhe- 
rent. How can we reconcile this process, which seems to 
imply a high degree of inflammation, with the absence of the 
violent and acute pain and the other symptoms above de- 
scribed I Many plausible answers might be given to this. 



432 LUNG FEVER. 

query; but the question not being of practical importance, we 
shall not discuss it. The distinction between pleurisy and 
lung fever is sufficiently obvious; but it is much more difficult 
to decide, whether the pain in full respiration, the hard pulse, 
and the short dry cough, may not be owing to a c;\ 
rior to the pleura itself, and situated in the intercostal and 
pectoral muscles; in other words, whether they may not be 
rheumatic in their character. In I, the presence or 

absence of other rheumatic symptoms, as pain in the move- 
ments of the arm and shoulder, will help to deride the ques- 
tion; and there is a peculiar p eition in which, if the pain be 
muscular, the patient will be likely to complain: viz. stand- 
ing upright on the foot of the a. the other 
bent ami n the toes. This position bra< 'hole 
side, and tests the soundness even <>i the intercostal row 

Alter all. this distincti d.uv i 1 1 • | 

in a rheumatic inilammat". 

with acute pleurisy , the to appropriate to acute plug 

would be demanded. 
\\ < li.i\ e already said, that in l 
may often 1m- prompt]) relieve .. without 

any additional n Died) li is i this 

source is not i follow up its • lister ami 

an active catbart - in he 

added. 

Lung Fever. The- r are acute pain in the 

breast, with lassitude, and . accompanied 

ally with chill, ami, sooner or later, with pain o: ten- 

sion and weight upon the part. The chill is followed by _ 
heat, ami presently an acute and pungent pain SttSI 
pari of the chest, more frequently the middle of one Bide, 
tending to the collar-hone, and > the shoulder. The 

breathing becomes frequent and short, with a hard, oft rep. 

and painful cough, and an c\ ion of frothy or viscid cha- 

racter, becoming tinged with hlood or baring this appearance 
from the first, sometimes, however, grei 

in seme - wholly wanting. The indication from 

the pulse is uncertain: sometimes this is hard, full, frequent; 
sometimes frequent he metimes not g the na- 

tural standard, or eve: intermittent. 

The action o( the heart d often accompanied with 

a sense o( heat ami horning. The countenance is flushed, some- 
what tumid, ami the li; ! d livid; hut sometimes tin 
general paleness and a contracted arking a collapse. 
There is often an sbundant and viscid sweat about the 
neck, and breast, while other parts of the body continue hot 



LUNG FEVER. 433 

and dry. The thirst is intense, with dryness of the tongue 
and throat, and difficulty in the act of swallowing. Answers 
to questions are uttered with hesitation, and with frequent in^ 
terruptions. In regard to position, that on the affected side is 
generally- preferred; but sometimes, the only posture which is 
at all tolerable is that on the back, with the head and shoul- 
ders elevated. 

The symptoms heretofore enumerated may be considered 
as common to all well marked cases: there are others which 
belong only to the most severe, and may be considered as in- 
dicating a fatal termination. Such are, extreme redness and 
prominence of the eyes; swelling of the tongue; stupor or de- 
lirium. With these, in fatal cases, the usual precursors of 
death are manifested in about seven or ten days. 

A favourable termination is brought about in different ways. 
Sometimes bleeding takes place from the nose, by which, with- 
out other apparent evacuation, effectual relief is obtained. More 
generally, the secreting surfaces of the lungs themselves pour 
forth an increased quantity of matter, varying from the tough 
glairy character of the ordinary catarrhal sputa, to the con- 
sistence of true pus. Most frequently, these two kinds of 
discharge are mixed, the mucus serving as a tenacious ve- 
hicle in which the purulent matter is enclosed. The tinge 
of blood in the sputa often alarms the patient or his friends; 
but it is merely an effort of the small vessels on the surface 
of the pulmonary passages to relieve themselves of distention 
by pouring forth their contents. By this expectoration, the 
difficulty of breathing and pain are relieved, and the violence 
of the fever diminished. Sometimes it happens that no con^ 
Biderable discharge takes place from the lungs; but, in place 
of this, there occurs on the seventh, ninth, or twelfth day, 
a profuse perspiration, pouring from the whole surface; while 
the urine deposites a copious pus-like sediment. Sometimes, 
again, without either expectoration or sweat, the disease has 
been dissipated by unclouded urine, secreted in uncommon 
quantity, amounting in some instances to 12 pints in a day! 

Another direction is often given to the progress of pneumo- 
nia, by the formation of an abscess in the substance of the lungs. 
Why this should happen in a part communicating by so many 
passages with a natural outlet is not easy to say. The abscess 
thus formed may either discharge itself into the cavity of the 
pleura, forming an empyema, or it may open into the air pas- 
sages, and thus be expectorated. The occurrence of empyema 
has sometimes been detected during life, and the matter dis- 
charged by puncture. In some rare cases the opening has 
taken place spontaneously. When the abscess forms a com- 

55 



434 LUNG FEVER. 

munication with the air cells, a large amount of pus is at once 
discharged by cough. The subsequent history of these cases 
varies according to the strength of the constitution, the I 
ence of any tendency to consumption, and other circumst.i 
When recovery takes place, the discharge gradually lessens in 
quantity, and becomes of thinner consistence, ihe abscess gra- 
dually healing and contracting. When the system want 
gour to effect this result, t continues, hectic fever 

is developed, and the disease 101 jlmo- 

nary consumption. 

AJ; the first onset of the disease the lancet is indicated, par- 
ticularly if the combination ot nptoms with the 
pleurisy afford j that the pleura participati 
the inflammation. Where this in in 
the chest and difficulty of bren 1 considerable, the pulse 
full and hard, and the 

pain in Ihe head, blood should be drawn from the arm to a 
sufficient f to these 

symptoms. If lb 

to ;i surface of Ito it will b ucly 

after the bleeding 

the 1 1. .ches for an adult 

, and in proportion U>v a L If 

in the co.: »r four hours, ac . id be 

manil 1 particularly n emetic 

may be admit for it is 1 :non that 

pneumonia is dej. ...pru- 

dence and irregularity . com- 

bined with late I. 

most frequent 

BD under othi 2 condition of the stomach 

demanding an rom the \ 

darting pain in the I . accompanied by nausea. 

The employment of em 
vantage. It is one of I igon 
decided perspiration, and . which 
the d ng argu- 
ment in f imitati; it. 

The principal rei 1 be relied on 

at the outset oi ti. ! the 

application of blisters to the c: \hen 

employed at all. should alw ould 

be resorted to, only when, after dach coi 

other evidence is afforded . a bilious 

state o( the system; and the bill n the 

pain in thest ami soreness In n likl or ab- 
sent. 



CONSUMPTION. 435 

After the first 48 hours of the disease have elapsed, the pros- 
pect of terminating it by any immediately debilitating action 
on the system will be so far diminished, and the powers of th-o 
frame so much exhausted, as in general, to forbid the use of 
remedies in this view. The object now is to favour expecto- 
ration from the passages of the lungs: for this purpose, various 
articles have been recommended under the name of direct ex- 
pectorants. Of these the most efficacious, if, indeed, any of 
them can be depended on, is undoubtedly the squill. But a 
class of medicines which have been much more relied on for 
this purpose, are those which produce more or less nausea or 
inclination to vomit. The vast amount of secretion from the 
lungs which precedes and follows the action of an emetic, is 
matter of familiar observation; and this observation has been 
turned to account by giving to patients under lung fever small 
doses of antimony or ipecacuanha, enough to produce sickness 
without provoking actual discharge from the stomach. Em- 
ployed with discretion, this class of remedies will do good; 
but they arc too uncertain in their operation to be -the subjects 
of specific rules, and too powerful to be safely trusted in the 
hands of the inexperienced. To those, therefore, who, with- 
out regular medical education, are obliged to treat this stage of 
pulmonary inflammation, we can offer no better advice tjian to 
regulate the external circumstances of the patient on principles 
!y laid down under the head of fever; to give warm di- 
luent drinks prepared with barley, gum Arabic, slippery elm, 
&c, to apply a blister, should local pain or soreness recur, and 
to alleviate the annoyance suffered from cough at night by an- 
or opiate < ombining squills, ipecacuanha, 

and opium, in the proportion of a grain of the first two, and 
half this quantity of the third, in powder or pill, a prepara- 
tion is formed which is at once expectorant, diaphoretic, and 
anodyne, and which will generally relieve, for three or four 
hours, that tedious and hacking cough, the occurrence of which, 
during the hours of sleep, is among the most troublesome at- 
tendants on the disease. 

The serious objections to opiates are, that the sleep they pro- 
. if much fever be present, is not refreshing, and that their 
action is not favourable to the due performance of digestion, 
and the regularity of the evacuations. The first objection is 
met, in some degree, by combining the opium as above men- 
tioned; and sometimes more successfully, by substituting for it 
a fifth part of the same quantity of the morphia. The second 
evil must bo obviated by a judicious employment of aperient 
medicines. 

Consumption. We have above noticed the manner in 
which common inflammation of the lungs appears to termi- 



438 COXSUMPTION. 

nate in consumption. Probably, in most cases of pneumonia^ 
which take this course, there must have existed, previously to 
the occurrence of the disease, the peculiar structural derange- 
ment which predisposes to phthisis, which consists in the pre- 
sence of certain soft, yellowish bodies, called tubercles, or of 
a grayish substance, which is capable of assuming the same 
general character. It appears that in every fatal case of true 
phthisis which has been examined after death, one or both of 
these appearances has been found. 

A great proportion of the cases of consumption develope 
themselves without severe inflammatory symptoms, and ar- 
rive at full maturity almost without the subject of them 
pecting that he has had any serious disease. The commencing 
symptom is a slight and short cough, which soon becomes ha- 
bitual; but which is so little remarked by the patient, that, if 
asked the question, he will unconsciously deny having any 
COUgh wi In answer to more particular inqi. 

1 knowledges that he has had a slight cold, but bei 

himself to be wholly rid of it at present It may be obsc i 
however, by a little careful attention, that the breathing is 
easily hurried by motion, that there is some emaciation, and 
a diminished disposition to any fort T may 

continue fur a year or two. w ithout any other complaint on 
the part of th< , than thai ■ ore liable to take cold 

than formerly, and that cold produces cough. Th< 
vations may still prove temporary; relief may be procured, 
no alarm or SI ocrienccd. It is often ol how- 

ever, lint on some of these occasions, the cough is troublesome 
on the patient's lying down at night, and continues longer 
than in ordinary catarrh. 

The cough, thus incrcasi: [ nitting. is often unattend- 

ed, for a long time, by any expectoration whatever. But when, 
at length, it heroines mon ttended with the 

raising o\' phlegm from the hi cially in the morning. 

The discharge by d< p ppearancc, becoming 

more abundant, less transparent, and, at length, yellow or 
greenish; finally assuming a purulent, or. as the popular term 
is. corrupted appearani neither at this, nor any other 

time, does the matter thrown up, resemble pure unmixed 
More or less mucus, or viscid white phlegm, is mixed with 
it, and seems absolutely requisite, in order to enable the mus- 
cles concerned in the act of coughing to effect the expectora- 
tion. 

these changes advance, the breathing becomes more dif- 
ficult than before, ami the emaciation and weakness incr 
Many of the natural secretions are now checked; and fern 
particnlarlyi perceive a cha 



CONSUMPTION. 437 

the effect of tlpe pulmonary disease, though often regarded by 
themselves as the cause of the cough. 

Up to this period, the pulse may not have been materially 
affected; but feverish symptoms now begin to manifest them- 
selves by the occurrence of a slight chill, or, at least, a feeling 
of chilliness toward evening. This is the commencement of 
hectic fever. It is soon found that the fever observes its regu- 
lar periods, and that two paroxysms occur in the course of 
every twenty-four hours, with equally well marked, though 
somewhat different symptoms. The morning fever comes on 
about noon, the patient at this time experiencing rather heat 
than chill, with a flush in the cheek, which, as the disease ad- 
vances, becomes one of its most striking characters. Some 
remission then follows; but in the evening, another paroxysm 
•succeeds, in which the cold stage is decidedly predominant, 
so that the patient always requires an increase of clothing. 
This chill is followed, particularly towards the termination of 
the disease, by very abundant sweats, which, however, are 
never accompanied, and rarely preceded, by any sensation of 
warmth. These night sweats, as they are called, form ano- 
ther of the prominent marks of consumption. They increase 
in amount with the advance of the disease, and become very 
profuse toward the termination of fatal cases. In the progress 
of the affection, pain in one or other side is felt and becomes 
nearly constant: this is aggravated by cough, and in particu- 
lar positions of the body. Spitting of blood is another symp- 
tom, which always shows itself in the course of the disease, 
though it does not always attend its commencement. As the 
case approaches a fatal result, the tongue is observed to be- 
come peculiarly clean, red, and shining; the eyes assume a 
pearly lustre, and the feet swell. Still later, the mouth be- 
comes affected with aphthous eruption; and an obstinate loose- 
ness of the bowels, which rapidly exhausts the strength, makes 
its appearance. 

It is not the mere existence of tubercles in the lungs that 
constitutes consumption; for these have been found after death, 
in a large number of cases, in persons who have died of other 
diseases. It is, in fact, the morbid development, the inflam- 
mation and suppuration of the tubercle, which gives rise to 
consumption. Two objects, therefore, present themselves as 
practically important: first, to ascertain the existence of tuber- 
cle, and secondly, to guard against its development in phthi- 
sis. Of the hereditary transmission of consumption, no doubt 
is now entertained; and in examining the lungs of children 
born of consumptive parents, tuberculous formations have, 
almost always, been observed. Again, tubercles are common 
in scrofulous subjects; that is, in persons who, when children-. 



438 CONSUMPTION. 

were remarkable for a florid complexion, thick upper lip, and 
a tendency to swelling of the glands of the neck. But al- 
though these appearances. and others, which might he men- 
tioned, may inspire a suspicion of the existence of tubercular 
matter, they do not justifj ry decided measure to pre- 

vent its development. It would he desirable that pe; 
evidently predisposed to the : the in- 

fluences of a climate, in which theezciti consump- 

tion are rare or wanti Lly cannot he done 

in the great proportion of ea>cs, the i 

will he to avoid dden atmospheric 

changes which are calculated to induce i 'i be re- 

el in ind -. and cautious diffi- 

cult it is for one enjoy ing apparent i follow such rales, 

we need scarcely h injunction! 

idom. in 
pain in tl 

it, that t! 
of his condition. From this time. of minor rem 

are prop ch with i 

good luce the inflammatory 

the irritation; opium is 
given to quii ilomel to 

alter * intimon; >ecto- 

pro- 
duce momen*. 

all arc in turn abando 
the inconveni 
till, at lei 
and quid 

ire for consumption. 
tain it is, that pro- 

purulenl »tion, 

and I 
shown t 1 
eurred in which the ul been 

found ci( 

Were it pra< >r the lungs to enjoy for a * 

that repose which is p. i ased 

structure, the process of Ik m of 

an abscess, would be comp i this 

is impossible, the next 
der the task * , > is 

This will depend mainly on t the q' 

of the air breathed, and the quality of the hloo 

on. The latter is principally dependent on the qoalit 

food taken, and hence one 



SPITTING OF BLOOD. 439. 

ed, and nutritious diet. It is partly in this view that the ex- 
clusive use of milk as an article of diet has been proposed, 
and the result in many instances has been exceedingly favour- 
able to the plan. 

The regulation of atmospheric influence is at once the most 
important, and the most difficult part of the management of 
consumption. Changes from heat to cold, from dryness to 
moisture, and often the reverse, arc found to aggravate the in- 
flammatory action and increase cough. Hence the leading ob- 
ject of the sufferer and his friends is to place him beyond the 
reach of these changes, and render the medium which he in- 
hales as uniform as possible. This, among us, is sufficiently 
difficult to effect at all seasons; but in our winter and spring 
months it becomes peculiarly so. One of two modes of pro- 
ceeding must be adopted. First — To create and maintain an ar- 
tificial temperature by means of lire, preventing as much as pos- 
sible all unnecessary draughts of air; and, secondly, to seek a cli- 
mate where the winter is so mild as toadmit of constantexposure 
without danger. The first plan is so difficult and expensive, 
that it almost always fails. The success of the second expe- 
dient seems to depend on the stage of the disease at which it 
is adopted. Those who have resolution, at the first develop- 
ment of the characteristic expectoration and fever, to bid fare- 
well to country and to friends, and submit to the inconveni- 
ence of temporary exile, will, if judicious in their choice, al- 
most always find relief; while those who wait till the re- 
sources of treatment at home are exhausted, till cough, ex- 
pectoration, and night sweats have reduced their strength to 
the lowest ebb — till three-fourths of the lungs arc disorganized, 
and the remainder scarcely adequate to the performance of 
their functions, wjll too surely find that they have sacrificed 
the comforts of home without the prospect of an equivalent, 
and have turned their back on friends and kindred, only to 
find a grave in a foreign land. 

Spitting of Blood, When blood comes from the throat into 
the mouth, and is thence spit out, it is a question of great in- 
terest to determine, whether it proceeds from the posterior nos- 
trils, the throat itself, the stomach, or the lungs. The first 
< ase is easily distinguished, by the facility with which the pa- 
tient can cause the blood to appear by blowing the nose. The 
second is not likely to happen, unless preceded by some ob- 
vious disease or inflammation of the part, and the question is 
easily determined, by ocular inspection. The signs of distinc- 
tion between bleeding from the stomach, and that from the 
lun^s, are, firstly. The former is usually raised by vomiting, and 
the latter by coughing. This test is not quite certain; for vo- 
miting is usually attended by some cough, though the cough 



440 I'ULMOXARY HEMORRHAGE. 

by which blood is raised, is unlikely to be attended with vo- 
miting. Secondly, the blood, when it comes from the stomach, 
is usually in larger quantity than when from the lungs. Third- 
ly, the blood from the lungs is usually florid, and mixed only 
with a little froth and phlegm ; while that from I tch is 

darker, and combined generally with other substances peculiar 
to that organ. Fourthly, vomiting of bloc likely to 

happen, unless preceded by some mark f the sto- 

mach, and bleeding from the lui 
and other trouble about the With 1 

it is not easy to make an unwilling mistal 
remarks, though mostly ap| to both affections, will be 

especially applied to bleeding from the lungs, which 
(he more common and important 
Pulmonary ht morrha^ 

; 
them is ( -soon 

as discovered. In 
Dtrasted with 

extent, ihould 

by d iiiptoius «.i raacular fulness. 

In active 1. ih a full bounding 

pulse fhtthingt, sense I 

bleed at the outset, until the pulse b I. and th 

ing is rendered m It the d 

under tin it, it nm as passive, and the 

astringent ren \ l 

is to be placed in the vegetal) 
the most trustworl Jam and - 

mked with popular n ranch 

more employed than these, and one which in ac- 

tive hemorrhage, without preliminary blo<Hl-lett. 
salt. This hai the 

services of a ; 

UOIM cannot be fully i I I, but iu mar 

duces nausea, on which its .dent. 

It may be taken as rapidly Bi possible, in the dose 

spoonful or more re| 
or li\ i 

vourite remedy for hen .1 in- 

sed excitement, is the I It possess- .rious 

property of reducing the free, 

lient be kept, while under its influence, in a recumbent postal 
at least, without any chanj Lion. It I 

its effect by acting primarily on Um 

and is an article to be employe 

however, on hemorrhage, s 



ASTHMA. 441 

even when the seat of the bleeding is at a great distance from 
the centre of the circulation. From fifteen to twenty-five drops 
of the tincture may be given to an adult, every two hours. 

In speaking of hemorrhage from the lungs, we have had in 
view a real discharge of florid blood in some amount, and not 
the mere coloured sputa which appear under a variety of 
circumstances. To these coloured sputa, as appearing in pneu- 
monia and phthisis, sometimes as a favourable sign, allusion 
has been already made. 

Astkmahaa been well described as "a difficulty of breathing, 
recurring in paroxysms after intervals of comparative good 
health, and for the most part unaccompanied with fever." 
Airain, asthma has been said to be " a disorder of the respira- 
tory organs, characterized by remittent dyspnoea, the attacks 
of wh ; ch genera II J return in the night, attended by circum- 
stances which are noticed more or less in all cases where 
there is some obstacle to the mechanism of respiration." The 
last is not exact as a definition, but it is valuable as referring 
to some points, which ought to be kept in view in attempting 
to gain a distinct notion of this singular disease. 

A paroxysm of asthma usually occurs during the soundest 
sleep, generally from midnight to two or three in the morning. 
The sleeper is awakened, after some: struggling and convulsive 
movement*, with a sense of impending suffocation, and of most 
painful constriction across tin: chest, which feels as if bound 
with cords, lb- is compelled immediately to sit erect, and in 
osition labours for breath in the most distressing anxiety. 
Frequently he flies to the window, where he sits or lean^ so as to 
inhale the air with lorn, regardless of any ex- 

The breathing, mean while, is accompanied with a 
uit wheezing, the extremities are cold, the face pale or 
livid, the eves staring, the heart palpitates, the pulse is weak 
and irregular. After these symptoms have continued for some 
time, cough occurs, with an cilbrt at expectoration. The mat- 
ter raised is sometimes merely a little frothy mucus; at other 
times mere viscid and heavy sputa, perhaps mixed with a little 
blood. In the last case, the expectoration usually proves criti- 
cal, and is followed by relief. The ordinary duration of a pa- 
im is from one to three hours. The frequency of attack 
varies, but a paroxysm like that above described, has been 
known to recur nightly for seven weeks together. 

Few diseases have given rise to more discussion with regard 
to their cause and nature, than that now under consideration. 
We will express our views on the subject, with all modesty, in 
a few words. 

The proximate cause of asthma appears to be a want of the 
proper change of the blood in the lungs, from the venous to 

50 



442 CAUSES OF ASTHMA. 

the arterial character, producing a demand for an increased 
supply of the purest air, which, during the paroxysm, is 
prevented from effecting its full purpose by some obstacle to the 
process of decarbonization, (see Function of L n,) either 

mechanical or nervous. Hence embarrassment of the left side 
of the heart, to which the blood is not sufficiently stimu!. 
to produce regular aciion. This disturbance of the circul. 
necessarily produces engorgement of the lungs, and hence the 
hurried respiration and sense of suffocation, which mark the 
attack. The exciting arc all those m« 

physiological agents which produce dii ition 

directly, by limiting the supply of air. or indirec: ard- 

i DLC the proper cl in the 1 

v. Ik n the air is pi i 

and much lata complete; it also lessens, probably in c> 
quence of ibis, the rapidity of circulation 

r in one I 
and t 

. one of 
causes of asthma. Propsyc/tl a, ossific 

nf anthracite, 
burned in ill-con- 
structed I: .uses of a 
diminished supply 
asthma. Chi' .ml warm at: 

sudden cold, the chilly s 

meat of the I 

humoral asthma. Wl pul- 

monary i 

the blood, is an <\ spasmodic asthma. 

Enlargement of the a i ml what is called emphynen \ 

of the lun. 

attendant on - a ex- 

citing cause of all the forn 

Occasional attat <usccpti- 

ble temperament, but in nod health, fi 
causes. Asthl 

duced by the sli^h : in others, by that 

o[' musk. w bay, i 

n o\ ncr\ on- il the un- 

folding of a cambric handi . at any hustle 

or hurry among her ai Jit of 

air h : and its 

ment may be perfectly ventilated, in 
spasmodic character, • 

opium eaters, when i f their as* 

ittack comes on a nd unless 



AXGIVA PECTORIS. 443 

supplied with opium, the patient expires in the course of a few 
hours. In the cases above described, the term nervous or spas- 
modic asthma is justly applicable. 

In a large proportion of the cases in which the disease is 
habitual, the resort to fresh air and free exposure seems to give 
the only relief which the circumstances allow. The pheno- 
mena of the tit, and the state of the lungs on which it imme- 
diately depends, would appear to point out the expediency of 
diminishing the furce of the circulation: but the more powerful 
agents we possess fur this purpose, such as blood-letting, nau- 
seants, &c, do more injury by diminishing the muscular 
force on which the maintenance of the respiration depends, 
than good by lessening the force with which the blood is 
thrown upon the lungs. Nauseants, however, arc occasionally 
resorted to, and in full habits, when the attack is violent, and 
threatens actual danger from suffocation, bleeding is decidedly 
proper. The latter can scarcely happen, except in the early 
attacks of robust subjects; for when the habit is formed, the 
fit is seldom fatal. Inhaling the fumes of tobacco, or the 
ei of the thorn apple, {datura stramonium) is a favourite 
remedy with some. The latter is a powerful narcotic, and, 
when smoked, produces temporary nausea with general re- 
laxation and reduction of the pulse. But it is a danger- 
ous plant. A strong tincture of lobelia, taken in the dose of 
fifteen drops at the commencement of a paroxysm, has also 

found to ailbrd relief; but this is also a dangerous 
article. 

The disease, now generally known by this 
name, has on! distinctly described within a few years. 

Its first attack often occurs in taking exercise after a full meaJ. 
The patient experiences severe pain in the front of the breast, 
extending towards one shoulder, more frequently the left, and 
shooting downward towards the arm and hand. The pain is 
such as immediately to check his progress, and induce him, if 
walking against the wind, to turn round and rest. After a few mi- 
nutes it subsides; but recurs again from time to time, the attacks 
lasting longer, and being accompanied with a sense of approach- 
ing suffocation. When once habitual, it is excited by the 

st muscular effort. Even coughing will bring on a parox- 
ysm. In this way the disease may continue many years, the 
patient, during the intervals, being apparently in possession of 
tolerable health. So capricious, however, do the paroxysms 

;e, that the dread of their approach is never absent. 
Every imprudence in diet, exercise, exposure to change of 
temperature and undue effort, is sedulously avoided ; purges, 
tonics, mercurial blisters, bathing, and the host of uncertain 
remedies usually brought to bear on incurable disease, are 



444 MUMPS. — eUIVST. 

tried in succession, but to little purpose. The - )mc- 

times, but rarely, - usly. More gem rail 

attacks recur with continually in . until, at 

length, in a paroxysm of unusual severity, overcome by pain, 
and struggling in all the agony of suffocation, the pal 
breathes hi- last la most of those who have'died of ai 
pectoris, more or less of structural of the heart 

been traced, although the appearand 
have not exhibited un\ uniformity. The 

frequent changes noticed li 

\ ftlves, a thickening < 'ii <<l lh< 

Sometimes b morbid appearand - 

organs remote from the beast, and in oiln-r instances no or- 
ganic change u h If the natui 

the disease be thai d uni- 

form nor 

riooally afforded by emetics, son i; and in 

the inten • with da 



N 1 
I of Iht Throat. 

Mumps, This inflammation of the parotid 

gland, li ii a hard, painful swelling, not extremely tender, 
appearing irid and 

the angle of the jaw, i m rious g<. rtorb- 

ance, or p l much frver in its ling 

increases till the thin! 
clines. The I 
to run its i v 

the d 
where it is ra 

demicallj . 
affords n • 

Quinsy. Of tl. mt quinsy, or ulc 

lion of th 

: for though il 
of inflammation occurs h the scarlet rash, 

vet the principles of ti 
nation, are equally SO w :. n it 
Passing over this, therefor. .11. under tin :ead. 



QUINSY. 443 

-consider only quinsy, properly so called, in which the inflam- 
mation tends, for the most part, to a phlegmonous or suppura- 
tive character. 

It commences generally without previous fever. The ex- 
citing cause is cold applied to any part of the surface, and par- 
ticularly to the neck when in a state of perspiration. At first, 
a sense of uneasiness is felt in the throat, which soon amounts 
to decided soreness, aggravated by every movement of those 
muscles which perforin the act of swallowing. On examina- 
tion, the tongue is found to be covered with white fur; the 
whole surface of the fauces is of a deep scarlet hue, and one 
or both tonsils >o swelled, as to fill up, in whole or in part, the 
interval which ordinarily exists between them and the uvula. 
The examination, necessary to ascertain the condition of the 
throat can be easily made, when the patient, sitting opposite the 
light, opens the mouth as widely as possible, and draws the 
air slowly in. During this last effort, the tongue is necessarily 
depressed, and a view of the diseased parts is obtained. If 
tin- expedient does not succeed, the tongue may be depressed 
by means of a spoon, or any article resembling it in form. As 
the swelling increases, the enlarged gland encroaches upon the 
uvula, pushes it toward the opposite side, and renders the rela- 
tion of the parts more difficult to discover: the difficulty of 
swallowing becomes extreme, and liquids, on which the attempt 
at deglutition is made, are forced into the nostrils. In extreme 
. breathing is also embarrassed : the voice, which in all cases 
is obscured, b nearly inaudible, and the countenance 

evidenci & In Ihis state of thing-, from 

the vicinity of the inflamed parts to the angle of the jaw, it 
often becomes difficult to separate the teeth to any extent. The 
natural relief i- d by the bursting of the tonsil, and the dis- 

charge of the contained matter, which happens from the fourth 
to the eighth day. It does not always happen, however, that 
the tonsil suppurate-, even when the disease is left to itself. 
lution may take place on the second, third, or fourth day, 
but if the symptoms have gone on actively beyond this time, 
suppuration may he deemed almost inevitable. When one ton- 
sil has broken, it is very common for the other to take on the 
same action, but the disturbance of the system is generally less 
with the second suppuration than with the fust. 

No disease more easily becomes a habit of the system than 
quinsy, and it will then recur on the slightest exposure, or 
in a manner wholly unaccountable. Though a most distress- 
ing disease, it is rarely fatal. 

In directing the treatment, regard must be had to the proba- 
bility of termination by suppuration. In many cases this must 
matter of conjecture; but if the outset of the inflamma- 



446 QUINSY. ' 

tion be peculiarly severe, if the di-ease be epidemic, and has 
been found in the great majority of instances to terminate in 
this manner, or if the patient have been liable to suppuration in 
former attacks, the chance of effecting resolution is small, 
we should encourage the suppuration. In doubtful 
same course will be advisable, for the follow The 

class of remedies which promote suppuration, cause in general 
less pain, and induce lei qaent debility, than those which 

have resolution for their object: and while we have lilt* 
deuce that the former throw ai le in the way 

of resolution where tin B tendency to it, we have 

son to believe that the latter impede the 
retard the result which the] I ipable oi 

vulsive measures should therefore be < uiion, 

and not continued when their inefli fairly 

shown. These remedi 
tics, purgatives, blistei i 

gargles ii ritory, that lit) d on 

them, pared 

by diluting go 'i' with an equal quantity . and 

adding ho I irritant! throat, the. 

moat popular i- 

cd the pn *l"l. T 

tended to acl as ta other inflamo !ood- 

lettiog has sometia 

ly to the tonsil or by scarifying the part with a lancet, i 

measures, though highly efl 

use. I y applied to the n< 

and there are tew situationi in wh 

effectual. Lastly, general bleeding 

derable extent in cases win il the 

diseai 'de to r< 

the operation, Iter decw 

increase of febrile symptoms, which endentl 

arrest 

The means of promoting support 
simple. Tlu \ . for the i . in the inl 

pour from boiling water Of Vinegar, aim aoui- 

ticea to the throat. When the matt . and tl. 

- not readily bun ielf, it may I .1 by the 

lancet ; but sometimes the g 

the patient from opening the mouth sufficiently to render pos- 
sible the artificial opening. In i 
ened, it may he I to administer an 

the agitation that if 

In impending suffocation from i both 



croup. 447 

glands, in the commencement of the case, free and often re- 
peated bleeding is sometimes our only resource. 

Croup. The seat of croup is principally, though not solely, 
the trachea, a quantity of lymph being thrown out upon the in- 
ner or mucous membrane of this passage, which, hardening, 
forms a false membrane, and rendering the passage narrow, 
obstructs the breathing. Croup is most frequent in children, 
from the first to the fourth year, and plump, fat subjects are 
more likely to be affected, than those of spare habit The 
disease occurs at all seasons, but especially at times when 
changes of weather are frequent. The decisive symptom, the 
shrill sound produced by the passage of the air through the wind- 
pipe, which, once heard, can never be forgotten, developes itself 
a few hours after the first embarrassment in breathing is per- 
ceived. If this sign be absent, the case can hardly be regarded as 
croup, though the term is often misapplied. Other marks of 
the disease are a hoarse sonorous breathing, and a husky cough, 
sometimes wholly dry, but, at others, attended with expecto- 
ration of a purulent matter, in which may be detected frag- 
ments of the membranous formation above named. The voice 
is sometimes, but not always filtered. On examining the throat, 
it will be found of a deep red colour, and in the struggles of 
the child, a large quantity of pus will often be thrown up on 
the tongue. The disease, whether it terminates favourably or 
otherwise, is of short duration, often only a lew hours elapsing 
before relief is obtained, or death terminates the case. When 
the crins i- favourable, portions of the false membrane are some- 
times expectorated, but in other instances the sputa offer no- 
thing peculiar, in the most dangerous stage or degree of the 
ere is often to be remarked a mottled complexion, or 
a circumscribed llu>h in the cheeks. The pulse is small and 
quick, the eyes prominent and blood-shot, the pupils dilated. Vio- 
lent tossing alternates with lethargy according, to the difficulty of 
breathing. The immediate cause of death is either actual suf- 
focation, or the exhaustion incident to the rapid breathing, the 
laborious action of the heart, and the imperfect supply of air. 
Frequentlv, some hours before a fatal termination, the little suf- 
ferer falls into a state of torpidity, and death is met with sur- 
prising tranquillity. 

In treating croup, the remedies principally relied on, are 
bleeding, emetics, and calomel. Bleeding is employed, not only 
with the view of relieving inflammation, but likewise to 
diminish the engorgement of the lun^s. Emetics, also, apart 
from their general effect, tend powerfully to effect a dislodg- 
ment of the peculiar secretion within the throat. Calomel has 
enjoyed a large share of confidence in croup; but it should 
never be employed by the unprofessional assistant. 



44S cboup. 

In domestic practice, where medical advice cannot be in- 
stantly obtained, no time should be lost in waiting. Let the 
little patient be bled very freely at the commencement of the 
imethiog in the constitution of the child render 
bleeding decidedly improper. ', i a child of three 

years or u 

if necessary, in half an hour. Ifttl j do not 

duce vomiting, double its quantity or frequenc 
be very mild. \ omiti . and. it" it appear not 

in three hours, the warm bath romote it. 

The pur| iceomplished \\ i ! 1 1 extreme difficulty, but 

when free emi n, the patient, with ordinal 

warm d 
and the i 
a l< ■• .. 

diminished. All 

avoi ■!■ 

long it will ... 

essentiall 
wine in ' 

sirup, i^ a vi i\ in at and safe A 

single . . 

b both safe and 
The croup of adults, 
that aboi 

itself principally in th 

brok d the 

other p 11 re or 

i the th: ; the 

attack, accompank d with 
hut with little or no cough. The in flam 

; lymph, ami then to be 

ed in the larynx and wind 
difficult breathing, an: 

with tin- h mark croup in 

dren. Another differ that the 

Mimes the character of a im 

therefore, is seldom mixed with any solid n it consists 

principally of mucus or phlegm, md sometii 
disease is commonly fatal under any mode of treatment. It 
was probably this iat terminated ikl A'asb- 

ington. 



CHOLERA MORBUS. 449 



SECTION VI. 



Diseases of the Abdomen. 



Cholera Morbus or bilious cholera consists essentially in the 
vomiting and purging of bile. This may commence as a 
sequel of ordinary vomiting, when the contents of the stomach 
have been discharged, but its irritability continues; or it may 
occur spontaneously without any known cause of irritation 
being present in the system. In cither form cholera is espe- 
cially the disease of a hot climate, and never developes. itself in 
our own, except during the summer, or early in autumn. 

The remote cause of cholera, therefore, is heat applied to 
the skin; and the immediate eflect of this application is gene- 
rally supposed to be stimulation of the liver, and increased 
secretion of acrid bile; but it may with equal reason be sup- 
posed, that the immediate effect of the ovef-excitement of the 
skin is to produce irritability of stomach and nausea, and that, 
this cll'cct once produced, the secretion of bile follows as a con- 
rice. Cold, or arrested perspiration, following exposure to 
extreme and long continued heat, is among the most frequent 
exciting causes of the disea 

Tiie attack of cholera is generally sudden, the patient being 
roused from uneasy tleep or suddenly alarmed during the day 
by extreme nausea, and at once obliged to evacuate the stomach. 
In some cases, pain, acid eructations, and a sense of lassitude 
usher in the attack, in the order of events, the purging may 
precede the vomiting, but the reverse is usually the case. The 
matters rejected are, first, the undigested remains of food, if 
any, then bilious matter more or less mixed with mucus,' and 
then purer bile, varying from its characteristic yellow to a 
green, brown, or black hue. The dejections either continue to 
be bilious or change to a peculiar half watery discharge, 
which has been compared to the washing of fresh meat. 

Spasms, fust in the abdomen, and afterward in the extremi- 
ties, are a frequent symptom, and under the combined influ- 
ence of these causes, the strength is soon exhausted. If the 
case be violent, collapse succeeds, and death may follow in a 
few hours, unless the restorative power of nature, or the in- 
terference of art afford some relief. 

The stomach is the primary and principal seat of this dis- 
. and to this organ must the treatment be especially acl- 

57 



450 CHOLERA. 

dressed; for if, by any means, its irritability can be relieved, 
the management of the bowels will cause little trouble. 
When the disease is seen at its commencement, it will be of- 
ten sufficient to enjoin abstinence from those large draughts of 
water, which the thirst incident to the disease induces the 
patient to demand, but which are rejected as soon as taken, 
and to direct small quantities of warm aromatic infusions, 
such as those of mint, balm, chamomile, or horse-mint. But 
when the vomiting has continued for several hours; when the 
patience and strength of the subject are spent, and the more 
serious symptoms begin to manifest themselves, there is no 
longer any room for this inert treatment The arrest of the 
vomiting is urgently demanded, and must be effected at all 
hazards. Opium, camphor, and alcohol, have each a peculiar 
control over the stomach; and a combination of the three, 
which is offered by the paregoric tincture in common use, 
will, in a lar^c proportion of I found efficacious. Aj 

subsidiary means, a cataplasm of mustard to the stomach and 
the feet, a spi r to the pit of the stomach, and the use 

of small quantities of iced water, or solid ice. are strongly in- 
dicated. With tl g of the vomiting, the intestinal dis- 
charge* usually cease also; and so complete is the change, that 
it ia often found i to administer a cathartic soon after 
the arrest of the disease; for which reason we prefer giving 
a dose of ins of calomel, as soon as the vomiting is 
lulled for half an hour, in every severe case. 

Spasmodic or Malignant Cholera, though familiarly 
known in India, from time immemorial, has attracted atten- 
tion in Europe and this country only within seven or eight 
years; but. as genuine cases of this disease were occasionally 
met with in this country prior to the epidemic attack, as 
others are still showing ti, - in our large cities, and as 

it has once or twice threatened to become epidemic a second 
time, in certain sections of the country, a parsing notice of it 
cannot be supcrlh:- 

Spasmodic is distinguished from common cholera, by the 
degree o( its violence and fatality; by the nature of th 
charges; and by \ in which the nervou- 

tern is affected. In place of the bilious vomiting and pui i 
by which the latter is distinguished, the ^ov marked at 

its onset by a profuse discharge in both directions of a colour- 
less fluid, in which not a particle of bile can be traced, and 
which, from its peculiar appearance, has been compared to rice 
water. The cramp, which in the common cholera is an oc- 
casional concomitant only, and comes on some hours after 
the attack, is here among the earliest and m nit symp- 



CHOLERA. 451 

toms. The spasms, commencing in the muscles of the belly, at- 
tack in succession those of the thigh, legs, and feet, and after- 
wards those of the chest, arms, and hands. These cramps 
are fixed contractions of the body of the muscle, which is 
gathered into a hard knot with excruciating pain. In the 
course of a minute or two this relaxes; but it again returns or 
is transferred to others; so that the sufferer scarcely enjoys an 
instant of entire freedom. Sometimes the vomiting takes 
precedence, as in common cholera; but often the purging 
ushers in the attack, anil in some of the more rapidly fatal 
cases, it is the only evacuation. 

The collapse which sometimes occurs in the common cho- 
lera, as an immediate precursor of a fatal termination, is often 
the primary stage of the spasmodic disease. So sudden is its 
onset, that the patient is sometimes struck down, as if by 
lightning; passing at once from full health, to a state which 
may be compared to a living death. 

The collapse of cholera is so profound, that all the functions 
of organic life appear to be nearly suspended. The action of 
the heart is feeble and irregular; the pulse cannot be felt; and, 
if a vein be opened, it is with the greatest difficulty that a 
few drops of blood are obtained. Spontaneous vomiting or 
purging may not be present; but if any liquid is swallowed, it 
is often immediately rejected. The whole surface presents a 
peculiar blue colour, and the hands and feet, when examined, 
are found shrivelled, yet damp, like leather, after immersion 
in water. t The extremities are chilled and the eyes sunk; the 
tongue is cold to the touch; and a profuse cold sweat pours 
from the whole surface. Spasms are among the regular symp- 
toms of this stage, becoming less severe, in most instances, as 
it advances; but although they often cease for some time be- 
fore death, they not unfrequently continue even for an hour 
after life has departed. 

The voice is a peculiar, husky, or hoarse, but feeble whis- 
per, and the perfect self-possession with which the patient re- 
plies to questions in regard to his condition, coupled with the 
sepulchral tone in which the answers are conveyed, serves 
more than any other circumstance, to augment the horror of 
the scene. So complete has been the collapse, in some instances, 
that the vomiting, purging, and spasms, were all absent, and 
the whole duration of the disease has varied from a few mi- 
nutes to a few hours. We have seen death occur, in one case, 
within five minutes after the attack, and in several others, with- 
in an hour. Even in Paris and New York, individuals were 
seized in the street, with retching, vertigo, &c, and before 
they could be conveyed to an hospital, or any medical aid pro- 
cured, were found to have expired. 



452 CHOLERA. 

Even where ihe patient rallies from the state of collapse, 
the final result is not always favourable. A febrile stage, re- 
sembling typhus fever, often ensues, with loaded tongue, cool 
s-kin, torpor without sleep, and sometimes wilh delirium. 
This may terminate fatally, at the end of eight, ten, or twelve 
clays. 

Like all other epidemies, cholera has been most fatal at its 
commencement, and as it progressed has become more ma- 
nageable; probably, because the most susceptible subjects were 
the first objects of attack, and the epidemic influence was more 
slowly exerted upon those who, by their constitution and ha- 
bits, were best calculated to oner effectual resistance. Thus, 
the persons first seized have generally been the inhabitants of 
unhealthy locations, persons of irregular habits, and those al- 
ready suffering under disease. When these have been swept 
off in great numbers, another class become affected, among 
whom nil these predisposing causes are either absent, or i 
in an inferior degree. Whatever mode of treatment, there- 
fore, may have happened to be in vogue, during the prevalence 
of a mild epidemic, or when I one lias expended its 

force, obtains credit for the time: and hence, the numerous 
and contradictory plans of managing the disease which have 
been advanced with equal confidence. 

Without attempting even to enumerate these plans, we shall 
offer such remarks on the treatmei n to us best fitted 

for the guidance of the domestic practitioner, when medical 
assistance cannot be obtained: remarks founded on considera- 
ble acquaintance with the disease, acquired in more than one 
hemisphere. 

When cholera is ushered in by premonitory symptoms of 
diarrhoea, accompanied by occasional sinking spells, some li- 
vidity of the lips and nails, and frequently, wandering neural- 
gic pains, it is of the utmost importance to check these symp- 
toms at once, and this may often be cfiectcd by very simple 
means: a little lavender compound, taken occasionally, and 
followed by half a tea-spoonful of paregoric elixir — or a table- 
spoonful of the camphor julep, (though the preventive powers 
of camphor have been most ridiculously, if not criminally 
aggerated,) or a draught of strong mint tea, with a total avoid- 
ance of all food, except arrow root, the gruels, or panada, will 
generally succeed in twelve hours. Irritants are more to be 
dreaded than simple stimulants, and notwithstanding the low 
diet, a glass of good port-wine sangaree may be taken at din- 
ner time, by those accustomed to wine. If these remedies 
fail in cheeking the diarrhoea, or if this discharge be very pro- 
fuse, the following much more powerful prescription will 
rarely fail. 



C HOLER Aw 453 

Take of, Prepared chalk, 2 drachms. 

Powdered gum Arabic, 2 drachms. 
Pure water, 5 ounces. 

Mix them thoroughly in a mortar, and then 
Add, Laudanum, 2 drachms. 

Tincture of Kino, J an ounce. 

Dose — a table-spoonful every two or three hours. 

When the attack comes on, notwithstanding all our efforts, 
the practice must be much more energetic. If the vomiting 
be, as it almost always is, a prominent symptom, it may some- 
times be checked by giving a table-spoonful of common salt, 
dissolved in a tumbler of water — half to be given at once, and 
the remainder, if the vomiting continue unabated, in thirty 
minutes. A small injection of some stimulant tea, such as 
the horse-mint, (monarda punctata,) if accessible, or the com- 
mon garden mint, with two drachms of laudanum, will some- 
times aid in checking the vomiting. 

The moment that the efforts of the stomach are lulled, or if 
this result cannot be effected in an hour, then without regard- 
to the discharges, give fifteen grains of calomel, mixed with 
just enough molasses to enable the patient to swallow it. 

From the first, let hot bricks, or bottles of water, be applied 
to the extremities and the stomach, and if possible, have a light 
muslin bag or pillow case filled with hot bran, as a substitute 
for the bottles or bricks applied to the abdomen, which are 
managed with difficulty on account of their weight and form. 
Dry heat is greatly preferable to steam or moist applications. 
Administer also, a tea-spoonful of lavender compound, with an 
equal portion of paregoric elixir, every hour; let the patient 
chew slowly small pieces of ice, or if this be unobtainable, let 
him take frequently half a wine-glassful of the coldest water 
to relieve the urgent thirst ; and endeavour to relieve the mus- 
cular spasms by strong pressure with the hand, as they occur. 

When the patient shows a disposition to sink into collapse, 
mustard plasters should be freely applied to the wrists and an- 
kles, and when the collapse is confirmed, a large one should be 
placed on the abdomen, over which warmth should be con- 
tinued. 

In mature collapse, the internal medicines should be omitted, 
and in their place a table-spoonful of brandy or old whisky, 
with not more than an equal quantity of water, and ten drops 
of laudanum, should be given every half hour. Five grains 
of calomel every twelve hours may also be continued through- 
out the case. 

On the cessation of the discharges in the collapse, the lau- 
danum should be omitted, but the brandy continued; and when 
the cramps disappear, the heat applied to the surface should 



454 DIARRHffiA. 

be moderated. On the first signs of low, muttering delirium, 
which, we believe, never occur until after the final arrest of 
the discharges, the course of treatment should be changed, and 
that adapted to typhoid fever substituted for it. 

In those cases of instantaneous or very sudden collapse which 
are almost peculiar to tropical climates, wherein the pulse at 
the wrist is imperceptible at the moment of attack or within 
fifteen minutes thereafter — wherein, if fatal, death follows in 
from twenty minutes to twelve hours, and if the patient sur- 
vive twenty-four hours, he is considered safe, — the collapse 
must be treated with still greater promptitude. A towel, dipped 
in boiling water, and very slightly cooled by evaporation, should 
be thrown on the surface of the abdomen as quickly as possi- 
ble. It will seldom create a redness there ! A drachm of lau- 
danum should then be given, followed in ten minutes by a gill 
of brandy slightly diluted. The doses of brandy and laudanum 
above prescribed for the milder cases, may then be doablcd, 
and continued till the pulse return^. A dose of twenty grains 
of calomel may be given at any convenient and early moment, 
and dry heat and mustard plasters liberally employed. 

Recovery from these cam, where it occurs, i* usually \ 
rapid, and we have seen in several instances the sufferer, at- 
tenuated and with a loosened skin, still unretracted from the 
enormous loss of matter by the discharges, yet pursuing his 
usual avocations on the day succeeding the attack ! Indeed, in 
contradiction to received opinion, we believe that the morta- 
lity among the cases of sudden collapse, when the practitioner 
can reach the patient before death, will be found less com 
rable under fearless treatment, than in more protract 

Of course, these directions are intended for adults when the 
disease is epidemic, severe, and at its height, — and must be ren- 
dered proportionally more mild in young sons, seat! 
cases, more moderate epidemics, and the decline of even the 
severest. 

Diarrhoea or looseness consists in an increased frequent J 
the discharges from the bowels, the matter | Idom va- 

rying from its usual character, except in becoming more loose 
and watery. Each evacuation is immediately preceded by 
griping pain, which is relieved by the discharge itself, and 
not return, except with the succeeding sjtooL T1k i rally 

moderate, not extreme thirst: the appetite impaired, but not 
wanting; some tenderness is discovered on pi 
the bowels, and an unusual accumulation of fluid can be ; 
ceived within their cavity. This dis d by external 

influences of less activity, but of the same character, as those 
which produce cholera: but it is more frequent in summer, and 
especially in autumn, when the alternate action of heat and 



DIARRHCEA. 455 

cold is aided by the abuse of fruits and crude vegetables. A 
slight increase of evacuations, produced by indulging somewhat 
freely in ripe fruit, is not to be regarded as a disease; but a 
very moderate disorder of this kind, when combined with the 
influence of atmospheric changes, or operating on an unusually 
irritable constitution, may give rise to diarrhoea; and hence, 
excesses which may be practised at one time with impunity, 
will, at another, produce serious results. 

Diarrhoea, induced by exposure merely, may be regarded 
without impropriety, as a catarrhal affection ; and we have al- 
ready remarked, that among the modes in which catarrh of the 
lungs finds a natural termination, the transfer of the increased 
secretion to the alimentary canal is by no means the most unu- 
sual. Others, among less frequent causes, are certain affections 
of mind, as anger, disgust, and especially fear. In some per- 
sons, certain articles of diet, not generally injurious, will al- 
ways produce it. It is a very common attendant on the pro- 
cess of teething. 

The increased secretion from the coats of the intestines has 
undoubtedly a tendency to relieve pre-existing irritation, and 
therefore should not be too suddenly checked. On the contra- 
ry, it is often advisable to promote it, at the commencement, 
by some mild cathartic. For this end, a spoonful of oil answers 
perfectly well, or, perhaps still better, a few grains of rhubarb, 
which generally has an astringent after its cathartic operation. 
The effects of laxatives are somewhat various. Sometimes the 
discharges seem to be merely increased in quantity by them, 
without any change of character. More frequently, however, 
they check the disease until after the operation of the medi- 
cine, and this is especially the case when a slow cathartic, such 
as rhubarb, is exhibited. Sometimes the action of this last ar- 
ticle, even in its common dose, is simply astringent, and the dis- 
ease disappears, upon its administration, as if by charm. Even 
when the cathartic increases the discharge without changing 
its character, the disorder may cease spontaneously under pro- 
per regulation of the diet. Should it not do so, a grain of 
opium or twenty drops of laudanum may be given at night, 
and the cathartic repeated in the morning, if the diarrhoea 
continue. Even when the discharges are delayed by the ca- 
thartic, an opiate may be given, but is not often needed. The 
principal benefit of opium seems to be a check to the discharge 
of the secretion for a few hours, which prevents the necessity 
of rising during the night. Taken prematurely, and followed 
up as is sometimes recommended after every discharge, it often 
does unquestionable harm. 

The more general but all-important means of controlling di- 
arrhoea, are to be fround in rest, attention to the clothing, and 



456 DIARRHCEA. 

regulation of diet. Bodily exercise must be avoided ; a rule 
difficult to follow, while the disease is only felt as an oc- 
casional inconvenience, but one which is absolutely indispensa- 
ble. The skin should be protected by sufficient clothing, of a 
character to afford security against sudden chills; for which 
purpose flannel is the best of tissues. The diet should consist 
almost exclusively of the milder vegetables. The morning and 
the evening meal must consist of tea, or the shells of cocoa, or 
boiled milk with bread. Rice, sago, tapioca, or the simplest 
meat broth should form the dinner, and it is better to take it 
at short intervals than as a regular meal. 

Even after the disease appears to be checked, it is absolute- 
ly necessary to continue these precautions; for an imprudent 
exposure to the night air, a fatiguing walk, or a dinner, will 
often undo the labour and care of a week, or perhaps convert 
the disorder, from the manageable form in which we have 
hitherto considered it, into a true dysentery. 

In addition to the above, which is the common acute diar- 
rhoea, various forms of chronic discharges from the bowels are 
mentioned by authors, to which it will be sufficient to make 
very cursory allusions. One of termed while looseness, 

from the milk ranee of the dejections, which resemble 

lime-water. It occurs chiefly in persons in whom the functions 
of the liver have been much impaired by residence in a warm 
climate. It sometimes succeeds the bilious fever of our south- 
ern states, or is the effect of the combined action of external 
heat, and a stimulating diet. Though not rapidly fatal, it is 
cured with difficulty, and by repeated attacks finally exh 
the system. 

There is a disease called Uentery, in which the food pat 
through the bowels unchanged. Its proximate can 
creased irritability in the muscular system of the stomach and 
bowels, independently of the influence of cold, or any peculi- 
arly irritating quality in the food itself. The food is not. 
diarrhoea, urged through the intestines because it is indi_ 
ble; but it is undi the state of the intes! 

does not allow time for the nutritive juices to be absorbed. In 
(fibular looser* m the mucous membrane, pre- 

serving a tube-like form, are thrown off. — The dischar_ 
masses of fat. which are recorded in collections of medical cu- 
riosities, need only be mentioned. The common form of • 
nic diarrhoea, is serous or watery, and results frequently from 
the neglect of the acute form, which is allowed to become a 
habit of the system. The diarrhoea incident to the lat 
of consumption, and which always aceelera: tal termi- 

nation is ascertained to depend on inflammation and ul 
tion of the intestinal tube. The treatment of none oi the>L 
rieties should be attempted by the domestic practitioner. 



DYSENTERY. 457 

Dysentery. The characteristic symptom of dysentery, is an 
earnest desire to evacuate the bowels, followed by severe 
straining efforts, which expel a little of the mucus that natu- 
rally covers the surface of the intestine. This generally re- 
sembles a mass of jelly, is often mixed with blood, but always 
unmixed with any of the natural bilious discharge from the 
canal. This evacuation relieves the pain for the moment, but 
after no long interval, the same desire returns, and is followed 
by the same result. If, mean while, the true fecal matter is ex- 
pelled at all, it appears in small, dry masses, which appear to have 
been retained for an unusual period. Continued fever, which 
is increased towards evening, accompanies the disease, and, 
with the increase of fever, the local symptoms are also aggra- 
vated. As the disease advances, the true mucous character of 
the stool is exchanged for one having rather the appearance 
of matter from an ulcer or open sore. The termination is va- 
rious. Sometimes recovery is effected by a single remedial 
measure, sometimes after three or four days of treatment, and 
sometimes at the end of many weeks. When the disease is 
epidemic, and of severe character, the patient often dies with 
extensive inflammation; and, if neglected, the disease fre- 
quently passes into a chronic form. 

The slimy and bloody discharges in this disease, are un- 
doubtedly dependent on inflammation of the mucous membrane 
lining the bowels; but in what manner is the absence of the 
natural feces to be explained 1 By some, this has been attri- 
buted to a spasm or stricture of the large intestine, at its upper 
part, by which the feces are supposed to be mechanically pre- 
vented from descending; an explanation attended with some 
difficulties, and which we shall not stop to examine. 

The tenesmus, or straining in dysentery, is one of its most 
striking symptoms, and shows how completely independent of 
anv solid matter in the intestine, is the desire for evacuation. 

A tea-spoonful of semi-fluid matter arouses the activity of the 
part when in this irritable state, even more than actual disten- 
tion when the bowel is in health. This tenesmus, when the 
disease has continued for some days, becomes the cause of 
much pain and faintness, and at a later stage causes serious in- 
convenience, especially in children, by occasioning a protrusion 
'*- f the mucous membrane or bowel itself. 
TVv^-o treatment of dysentery in its incipient stage, the only 
one Winch we propose to consider, is simple. If evidently 
the result of excess, if accompanied with nausea or other 
symptoms of deranged stomach, or if simply attended with 
(ever and headach, an emetic will be highly proper; but this 
remedy is absolutely inadmissible when the disease prevails 

58 



458 DYSENTERY. 

as an epidemic. In these visitations the rules of ordinary ex- 
perience cease to guide us, and it is often found necessary to* 
omit remedies which, on general principles, seem decidedly 
called for. In ordinary cases the effect of an emetic, given 
at the invasion of this disease, is highly salutary, and often 
succeeds in arresting its progress. This may happen in va- 
rious ways. In the first place, there is a stronger sympathy 
between the stomach and the rectum and colon, than between 
any intermediate portions of the canal; and whoever has at- 
tended a chronic disease of the lower bowels, must have ob- 
served that there is no other cause by which this disease is ag- 
gravated so quickly and certainly, as by the presence of undi- 
gested aliment in the stomach, and that there are often no 
means of relieving an attack so certain as that of emptying 
this organ. In persons predisposed to dysentery, it is fre- 
quently found to recur immediately on committing an im- 
prudence in diet, and before the irritating cause can have 
passed beyond the stomach itself. Secondly, an emetic is 
often the most complete of all cathartics; producing evacua- 
tions in both directions, changing the whole secretion of the 
canal, and converting the existing affection into an artificial 
and very manageable form of cholera. Thirdly, an emetic 
is one of the most powerful sudorifics; and when the disease 
lias arisen, as often happens, from suppressed perspiration, this 
affords a direct means of restoring the suspended action. In- 
deed, we know of no single remedy so likely, when adminis- 
tered at the very outset of the disease, to effect a complete 
cure; but where the case has been suffered to run on un- 
checked to the second or third day, we cannot recommend 
this mode of treatment with the same confidence. Bleeding, 
which is sometimes necessary, can only be employed safely 
with limitations which it belongs to the experienced practi- 
tioner to estimate. The remaining remedies are a cathartic 
and an opiate. Which of these shall enjoy precedence of the 
other, is a question often settled by convenience alone. If, for 
example, we wish to afford immediate repose, which is often de- 
sirable at night, fifteen grains of Dover's powder may be given 
at once, and even repeated in four or five hours, if the morbid 
evacuations recur. Opium, given in this way. does not inter- 
fere with the subsequent operation of a cathartic. Its effect 
istodiminish increased sensibility, and moderate the augmented 
action. Its influence in both these respects is more likely tu 
be directed to the rectum, where both these derangement- 
ist, than to the intestines above, which are already in a s 
of torpor. Hence we usually find that for some hours after 
an opiate, although the canal may be still unrelieved, the irre - 



colic. 459 

•gular action is suspended. As a general rule, however, a mild 
aperient will be first administered. We cannot agree with 
those practitioners, however intelligent and respectable, who 
deny the expediency of giving cathartics at all, and advise 
that enemata alone should be trusted to for the removal of 
accumulations. This remedy is, however, a useful auxiliary 
in removing hardened feces, and is useful in other ways, if 
it be given in such quantity and of such temperature as to 
produce free perspiration, whrch it may easily be made to do. 

Among the collateral sources of benefit in dysentery may 
be mentioned external Warmth, which is as much needed and 
better borne in this disease than in cholera. Mucilaginous 
drinks, such as flaxseed tea, barley and gum water, mucilage 
of slippery elm bark, and of the pumpkin seed, are grateful, 
and do much good by lubricating the surface of the canal. 
The use of blisters to the bowels in the early stage is seldom 
needed; that of warm fomentations is highly advisable. The 
excoriation about the lower passage is a source of great an- 
noyance, and is best relieved by the application of unsalted 
lard. Another troublesome, but necessary precaution in chil- 
dren, is to oblige them, from an early period, to allow the eva- 
cuations to pass from them in a recumbent posture. This 
will much diminish the straining. The last two directions 
belong to the treatment of the disease, if protracted; but they 
are addressed to the nurse rather than the practitioner, and 
may therefore be pardoned. 

The after treatment of dysentery, and the management of 
'the dreadful varieties of this disease often seen in hot climates 
and during certain epidemic attacks in temperate countries, 
are subjects on which we dare not give instructions to the po- 
pular reader; for the employment of the formidable measures 
necessary in some of these cases might prove, in his hands, 
more dangerous than the disease. 

Colic. An intermittent, griping pain in the belly, princi- 
pally about the navel, forms the general and leading symptom 
of colic. It is often met with as a concomitant of some of the 
affections elsewhere noticed, as of surfeit, flatulence, costive- 
ness, &c. Viewed as a distinct disease, however, it embraces 
a frequent and important class of cases, to which the sudden- 
-ness of the attack, the severity of the pain, and the necessity 
of prompt and efficient measures, impart peculiar interest. 

We have said that the pain in colic was intermittent. The 
intervals, however, are of much less duration than in diarrhoea, 
and the disease is unaccompanied by discharges downward. 
The navel is generally retracted during the pains. There is 
vomiting, sometimes of undigested food, sometimes of bile; 



460 colic. 

and in the very severe cases called iliac passion, the contents 
of the bowels themselves are thrown up. 

The causes of colic are. among others, the application of 
cold to the body when heated, long continued costiveness, the 
abuse of emetic and cathartic medicines, imprudence in diet, 
under the influence of mercurial or other medicines; opium- 
eating, the use of crude and indigestible vegetables, and excess 
in eating. The immediate cause is constriction of the bowels. 

The objects in treating colic are, to remove the offending 
cause, to relieve pain, and to procure an evacuation from the 
canal. An emetic is often advisable, even if we are not per- 
fectly certain of the presence of offending matter in the sto- 
mach. When there is nausea, sense of oppression, and head- 
ach, and no spontaneous vomiting has occurred, the necessity 
of an emetic may be regarded as unquestionable. When spon- 
taneous vomiting has occurred, but the nausea and headach 
continue, the same remedy will probably bring away bile, and 
afford ultimate, though not very prompt relief. Jn these cases 
we suppose an offending matter to have been present; but 
even though the stomacli may have been empty from the com- 
mencement, an emetic may still be of service by producing an 
increased flow of Ule, and favouring the evacuation of the 
bowels. On the other hand, this remedy is decidedly objec- 
tionable when the action of the intestines is inverted, and a 
vomiting of feces is present ; when the pain is extreme and 
demands instant relief; when vomiting has produced general 
exhaustion or collapse. Of the first of these cases, which is 
termed iliac passion, and constitutes the most dangerous form 
of the disease, we shall speak hereafter. 

For the relief of pain, the most powerful remedial memos 
possess, are blood-letting and opiates. Where active symp- 
toms must be checked at all hazards, there is no remedy, the 
effect of which follows so immediately as that of bleeding In 
live minutes, it may often be made to produce fainting: in 
which state, for the moment at least, relief is certain. " An- 
other advantage of bleeding is, that it favours other evacua- 
tions. If employed when the stomach is full, unless this o 
is peculiarly debilitated, it produces vomiting. It also pro- 
motes evacuation in the opposite direction, as is proved by the 
patient being often compelled, even in the severest cases of 
colic, to go to stool before the arm can be bandaged. It is the 
most powerful of all anti-spasimxlies, and also favours sweat- 
ing. Bleeding, therefore, in emergencies, is the most valuable 
remedy we possess. It is interdicted, like emetics, when con- 
tinued vomiting has produced much exhaustion. Opium i* a 
valuable medicine in colic, and frequently acts most satisfacto- 
rily in relieving both pain and spasm. It is particularly de- 



colic. 461 

manded when an active bleeding has reduced the vigour of the 
circulation, and when nothing remains but an obscure sense of 
pain with a feeling of debility. 

In the form of laudanum, or paregoric elixir, it often serves to 
relieve the vomiting, with which each return of the pain is 
sometimes followed. The last object is still more certainly 
efFected by opiate injections, consisting of some warm mucila- 
ginous liquid containing from twenty to thirty drops of the 
laudanum. The use of opium has been objected to, as tending 
to produce constipation, and thus to interfere with the subse- 
quent operation of purgatives; but though opium tends to check 
the natural evacuations, yet this effect does not seem to be 
proportional to the dose; and after very considerable quantities 
have been given for the relief of pain or spasm, it is- not found 
that cathartics act with much less force than before; some- 
times, indeed, they act even more readily, for cathartics taken by 
mouth will not usually operate, until the pain and the irritability of 
the stomach are subdued. Cathartics, given by way of clyster, 
in any stage of the complaint, are often highly serviceable. In 
some of the most obstinate and protracted cases of constipation 
in colic, relief has been obtained by the gradual introduction 
into the rectum of large quantities of warm fluid, from four to 
five pints, for example, either uncombined, or with the addi- 
tion of some oily ingredient. It is doubtful whether this remedy 
reaches the actual seat of obstruction ; but the general relaxa- 
tion of the whole system, evinced as it is by profuse perspira- 
tion, is sufficient, in itself* to explain the result. This simple 
expedient deserves to be tried, in every case where serious 
difficulty is met with in effecting evacuations. Among cathar^ 
tics, the most proper in this disease are those which are most 
likely to be retained by the stomach; and this is especially the 
case with those which can be given in a liquid form, and pos- 
sess a certain aromatic flavour. Even before the morbid irri- 
tability of stomach is wholly controlled, small quantities of some 
compound infusion, like that of senna, given at intervals and 
steadily persevered in, will often restore the bowels to their 
appropriate functions. 

Among the less powerful auxiliary means, employed in this 
disease, are fomentations and blisters. The continued appli- 
cation of heat and moisture, will be found to afford very con- 
siderable relief, in many instances. External irritants, such 
as rubefacients and blisters, are not deserving of so much con- 
fidence. They require much time, and, when they fail, in- 
crease the suffering of the patient. 

The form of colic, termed ileus or iliac passion, is distin- 
guished by the inverted action of the intestinal canal, through- 
out nearly its whole course; so that apparently fecal matter 



462 painter's colic. 

-is actually forced upwards, and rejected from the mouth. 
The pain in this disease is severe, and the danger imminent. 
It is extremely difficult to determine the condition of the in- 
testine during life. After the termination of fatal cases, one 
portion of intestine is sometimes found to have descended 
into and become enclosed by another; and, in some instances, 
nooses or knots have been formed by the bowels; the encir- 
cling portion being even drawn so tight as to produce stran- 
gulation, followed by gangrene. Our remarks on the treat- 
ment of this form of colic, are designed merely to prevent 
the domestic practitioner from doing mischief, by employing 
certain remedies useful in common colic, but fatal in ileus — 
it would be folly in the unprofessional to undertake any de- 
cided responsibility in the management of the latter, except, 
perhaps, to employ a few very obvious precautions. This 
disease almost always baffles the wisest, and. nature may be 
more safely depended upon than the blind efforts of the igno- 
Tant. 

Blood-letting, fomentations, and injections are. at least, as 
decidedly indicated in this form as in the preceding. Vomit- 
ing is of course forbidden, and cathartics are generally ren- 
dered useless by the irritability of the stomach. Calomel, in 
conjunction with opium, and sometimes one or the other se- 
parately, have been known to check the vomiting, and then 
cathartics have proved effectual. Beyond this, the rase must 
be left to nature or the physician. 

Painter's Colic. This form of colic is distinguished from 
every other, partly by its cause, which is the absorption of 
lead into the system, and partly by certain peculiarities in its 
progress, which we shall proceed to notice. The pain is 
usually seated, from the beginning to the end of the attack, in 
The pit of the stomach: from this point, it passes upwards into 
the arms, and downward to the navel, back, loins, and lower 
portion of the abdomen; sometimes extending to the thighs 
and legs. Along with this pain there is great external sore- 
ness, so that the patient is scarcely able to bear the slightest 
pressure. The bowels are firmly bound from the commence- 
ment of the disease. Nausea and retching begin on the se- 
cond or third day, and are followed by vomiting of slimy and 
bilious matter. As the pain increaa attacks of retch- 

ing and vomiting become more frequent and severe, and con- 
tinue till a favourable change occurs. Toward the close of 
the disease, the feet sometimes assume a red and swollen ap- 
pearance. The first symptom of a favourable change is often 
profuse sweats, accompanied by a rash. The pain now be- 
comes more tolerable; the patient feels an earnest desire to 
evacuate the bowels, and, on making the attempt, succeeds in 



painter's colic. 463 

passing away some masses of hardened matter, of a rounded 
form and perfectly dry. When the disease has recurred se- 
veral times, which it will continue to do from the same cause, 
the upper limbs are at length attacked with palsy; the fingers 
become contracted from a loss of power in the extensor mus- 
cles, so that when the arm is extended, the hand hangs down; 
and the limb thus affected, gradually shrinks. The fit itself 
is not often fatal. Its duration, under, the most favourable 
circumstances, and the most judicious treatment, is seldom 
less than five or six days. 

The disease was at one time termed the Devonshire colic, 
or colic of Poictou, from being most common in those parts 
of England and France. The reason of its prevalence in these 
places, was discovered by Sir George Baker, who ascertained, 
that the cider of the former country, and the light wine of the 
latter, contained, in solution, a certain amount of lead. The 
announcement of this occasioned great alarm to those accus- 
tomed to drink water from leaden pipes, but it is found that 
water, when pure, does not possess the power of dissolving 
metallic lead, and may, therefore, be kept in it, for any period, 
with entire impunity. 

The laws of the action of this poison are involved in much- 
obscurity. The most deleterious mode of exposure to its ef- 
fects, is the inhaling, in large quantities, the fumes which 
arise from fresh paint, which is prepared by grinding white 
lead in oil. Lying for a few hours in a close room freshly 
painted, has proved sufficient to produce colic, palsy, and even 
sudden death. The following case, known to the author, il- 
lustrates the rapidity with which a fatal result may take place. 
A painter of irregular habits, returning to his lodgings at a 
late hour, and being unable to obtain entrance, went into the 
shop where were some window-blinds just painted, shut him- 
self in and went to sleep. The next morning he was found, 
suffering great agony, but already paralytic. About noon, he 
expired. 

All persons habitually exposed to the contact or inhalation 
of the oxydes of lead, are liable to attacks of colic. The ma- 
nufacturers of white and red lead are the greatest sufferers; 
then come painters, miners, plumbers, type founders, glaziers, 
potters, and printers. In all these, the liability to the action 
of the poison, is very greatly increased by want of cleanliness 
in the poison and clothing, and by intemperance. The abun- 
dant use of animal fat as an article of diet, is said to be a pre- 
ventive. 

The attacks, when they occur, seldom yield to any other 
treatment than the persevering use of purgative medicine; and 
no advantage appears to be gained by resorting to the more 



464 LIVER C03iPLAI>'T. 

violent remedies of this class. In many instances, the disease 
will yield to the continued use of castor oil, in small doses, 
repeated every two or three hours. This may be aided, in 
obstinate cases, by injections of the same article, or of oil of 
turpentine. Where these remedies have failed, tobacco has 
been resorted to, and in some instances, the external applica- 
tion of cold water has produced a salutary shock; but these 
are dangerous and uncertain remedies, and only justified by 
unusual emergencies. The fact we have mentioned already, 
that the disease will, to a certain extent, have its course, must 
be kept in mind; or the strength of the patient may be ex- ■ 
hausted, and unnecessary danger incurred by attempting to 
effect, prematurely and violently, what nature, if left to her- 
self, would perhaps be able to accomplish. 

Liver ( 'ompUunL The presence of inflammation of the liver, 
is recognised by the following symptoms. Together with chill 
and lever, there occurs pain on the right er the arches 

of the false ribs. The pain is accompanied with some degree 
of soreness, and tenderness on Daily 

yellow, and the stools clay-coloured. Thirst, a furred tongue, 
and nausea, are also symptoms; and there is short di 
dependent, as is generally thought, on irritation of the diaphragm," 
with which the liver lie's in close contact. Some varie 
produced in the signs of the disease, by the particular seat of 
the inflammation. If it be on the surface of the oriran. the 
suffering is greater than when it is more deeply seated. On 
the other hand, jaundice is a more prominent symptom, w 
the disease affects the substance of the orscan, than when it is 
limited to the surface. In the latter case, the duration of the 
disease is often short, and resolution takes place on the third, 
fourth, or fifth day. This result is often marked by critical 
hemorrhage from the nose, by copious bilious discharge from the 
bowels, profuse sweat, or turbid urine. Inflammation of the 
substance of the liver, when not checked, occasionally forms 
abscess; an occurrence recognised !»•• hills, and external 

swelling over the part, son:' rtiuct hut 

deep-seated fluctuation. 

The course taken by the matter, under these circui 
is various. Sometimes it approaches the surface, and the sur- 
geon is enabled to give it vent : sometimes it dischar. 
into the neighbouring portion of intestine : in which case the 
pus is discharged by vomiting or . often producing a fatal 

termination within a few hours; and sometimes it passes through 
the diaphragm into the chest, opening either into the pleural 
cavity, where it forms an empyema, or into the lungs, from 
which it is rejected in large amount bv the mouth. In a 
instances the abscess has been known to open into the cavity 



LIVER COMPLAINT. 465 

of the abdomen, where it produces extensive inflammation and 
death. Abscess, however, from acute hepatic inflammation, s 
rather uncommon in temperate climates. The substance of 
the organ is more likely to take on other changes, to become 
indurated and altered in structure, with increased liability to 
irritation from the action of remote causes; and thus the in- 
flammation is rendered chronic. In this form, the pain is less 
acute, and there is less sympathetic disturbance and general 
fever. Both acute and chronic inflammation of the liver, are 
frequently accompanied with pain in the right shoulder, a symp- 
tom too vague to be much depended on, and one to which un- 
due importance has been attached. 

Inflammation of the liver is seldom a subject for the domes- 
tic practitioner, and it is then generally the acute form, induced 
by excess or atmospheric vicissitude, which demands his assis- 
tance. 

The abuse of drastic cathartics, especially such as are com- 
monly sold as specifics, will sometimes bring on an attack of 
this kind. In these cases the presence of nausea and jaundice 
will render proper the administration of an emetic; and if chill 
and general fever be manifested, a gentle perspiration must be 
excited and encouraged, the bone-set tea, and sweet spirits of 
nitre being among the best means of effecting this purpose. If 
the emetic fail to move the bowels, a gentle dose of salts or 
oil may be employed for this purpose. 

General bleeding is not found to exert the same beneficial in- 
fluence in this disease, which it exhibits in pleurisy or lung fe- 
ver. It is useful at the outset, in severe cases; but it must be 
vigorously followed up by cupping or leeches, to the affected 
side. These may be advantageously succeeded by fomenta- 
tions, or, when the force of the pulse has been diminished, by a 
blister; the latter being best suited to the superficial form of in- 
flammation, the former to that which is deeper seated. The 
farther treatment will naturally come under the cognizance of 
the regular practitioner. The occurrence of severe and re- 
peated chill, after the second or third day, will inspire a suspi- 
cion that suppuration is taking place, and suggest the neces- 
sity of employing those means which are found to accelerate 
this process; of which, heat and moisture externally applied 
are the most important. The care and management of hepatic 
abscess, however, demands all the resources of practised surgi- 
cal skill. 

Chronic inflammation of the liver, though, as above stated, 
frequently a sequel of the acute affection, is often developed 
insidiously, and, under this form the disease deserves a sepa- 
rate consideration. As seen in temperate regions, it is often 
induced bv long continued habits of excess, or supervenes in 

59 



468 ; irrrLAMMATiox of the kidney. 

obstinate intcrmittents. It is indeed generally accompanied 
with fever of remittent character, having a daily evening exa- 
cerbation. The pain is often obtuse or even absent; but the 
organ, on examination, will generally be found harder and 
larger than natural, while the digestion is imperfect, the bowels 
costive, and the stools usually ciay-coloured. This form of the 
disease is too often the index of a decayed and broken consti- 
tution, and, as such, yields with great reluctance to the most 
judicious treatment. 

Inflammation of the Kidney. The symptoms of infiam- 
rnation of the kidney are. in general, pain in one of the loins, 
shooting toward the bladder; numbness of the affected side; 
continual desire to pass urine; vomiting; and retraction of the 
testicle. The disease is most frequently dependent on ob- 
struction of the ureter by some mechanical obstacle, especial- 
ly calculus: it sometimes also results from mechanical violence, 
or from poisoning by Spanish flies. In these instances the 
symptoms are strongly marked, and the history of the case 
points out its character: but sometimes the only assignable 
cause is cold; and in these cases it is not always easy to dis- 
tinguish the affection from rheumatism. In the latter, how- 
ever, the pain is usually felt in both loins: there is no desire 
to urinate, no pain in the course of the ureter, and no retrac- 
tion. That the symptoms indicate actual inflammation, and 
not mere neuralgic affection of the kidney, must be inferred 
from their constancy and from the state of the pulse. It often 
happens, for example, that the presence of a 
or other cause may give rise to nervous irritation, accompa- 
nied by many of the signs of inflammation: but in tl. 
the pulse is comparatively but slightly affected, and the pains 
generally exhibit, decided remission. 1> 

generally rr.n>< high: and i^ singularly marked by frequent mo- 
mentary chills. Acute inflammation oi the kidney, not de- 
pendent on mechanical injury, is usually relieved, under active 
treatment, in from twenty-four to thirty-six hooi 
being often accompanied with a cop ' of urine, 

times, however, suppuration of the organ follows: in this i 
the pain is su< . on the third or fourth day. by tor 

heaviness; of the part, and soon nft< r 1 chill superv 

The matter is sometimes discharged by the bladder, some 
by an external opening, and - e ab- 

domen. The first, as might be supposed, is the most favoura- 
ble termination: (he last is almost certainly fatal. 

The remedies for this form o( inflammation, are vig. 
general, and local bleeding, the hot bath, fomentations to the 
loins, and large injections of as elevated a lemperatui 
"be borne. Saline purgatives, and the sweet spirits c( nitre, a 






JAUNDICE. 467 

tea-spoonful every half hour, until relief is obtained, may be ad- 
ministered with great advantage; and narcotics are occasion- 
ally, but seldom, demanded by the violence of the pain. When 
suppu ration occurs, the exit of pus must be promoted by the 
measures alluded to in treating of inflammation of the liver. 

Jaundice is recognised by the yellow hue of the skin, which 
is most marked on the chest, and which extends itself to the 
membrane covering the eye-ball, and to the nails. Along with 
these appearances, the stools will be found more or less clay- 
coloured; while the urine, on the contrary, is of much deeper 
tint than ordinary, and communicates a decided yellow tinge 
to paper and to linen. These changes are commonly ex- 
plained by supposing that the bile secreted by the liver is pre- 
vented from getting into the intestines, and that, enterino; the 
blood as bile, it is thus carried into the cutaneous vessels, and 
imparts to the skin its peculiar colour, while the office of con- 
veying it out of the system is transferred for the time to the 
kidney. It is probable that, in some cases, the phenomena of 
the disease depend upon this circumstance. Yet some dis- 
tinguished chemists have been unable to detect any bile in the 
blood of jaundiced patients, and, on the other hand, there are 
many instances of decided jaundice, in which the discharges 
from the bowels have been found of their usual colour. Those 
who maintain that the ducts are obstructed in jaundice, ascribe 
this obstruction mainly to two causes : first, spasm of these ducts, 
themselves; and secondly, the presence of gall-stones filling 
their cavity. But the occurrence of the former is at variance 
with the structure of these canals, and the passage of a gall- 
stone is a rare occurrence, and when it takes place does not 
always produce the symptoms of jaundice. But whatever be 
the difficulty of determining the immediate cause of jaundice, 
its remote or occasional causes are sufficiently obvious. Jt is 
generally brought on, either by imprudence in diet, such as eat- 
ing fermentable, acrimonious, or otherwise indigestible food, by 
drinking cold water when heated, or by mental emotion. The 
latter may be either sudden, as a burst of anger or terror, or 
gradual, as depression and despondency- Long exposure to 
external heat produces jaundice, as is evident from the yellow- 
ness of skin exhibited by those who have long resided in very 
hot climates. 

The attack commences with a sense of fulness at the sto^ 
mach, attended with nausea and pain. To these succeed vo* 
miting, and the rejection of all articles of food or medicine, 
The pain increases in severity, and shoots toward the left shoul- 
der or spreads to the loins. The belly is usually distended; 
and the bowels costive. The deep yellow of the urine in the 
progress of the malady often changes to a dark red, like t.hg 



468 PASSAGE OF GALL STONES. 

colour of venous blood. When the disease extends to the hu- 
mours of the eyes, surrounding objects are seen tinged with yel- 
low. The colour of the skin often continues after all the other 
symptoms have disappeared, and sometimes even the bones 
have become tinged with it. Long continued jaundice, how- 
ever, generally depends on, or is connected with, chronic dis- 
ease of the liver itself. In this case there is generally no pain, 
but the digestion becomes deranged, and the strength is gradu- 
ally impaired. This is the form of the disease which is brought 
on by long continued residence in hot climates, especially in 
persons of luxurious habits, and also by frequent attacks of re- 
mittent and intermittent fever. 

In the ordinary treatment of jaundice, the chief object is to 
stimulate the liver to a healthy secretion. • For this purpose, 
an emetic is usually given at tirst, which at once excites an in- 
creased flow of bile, and causes it to be thrown into the sto- 
mach itself. This treatment often produces entire relief. If. 
however, the jauntiiced hue of the skin continue unabated, the 
emetic must be followed by a cathartic/, in which calomel 
should at least form a part. Five grains of this article, com- 
bined with two or three times the quantity of jalap, forms an 
excellent purge in cases of this description. With this, active 
treatment may be closed : but the dil ;nptoms which re- 

main, may still require attention. The I and tender- 

ness on pressure, in the region of the stomach and the liver, 
may be relieved by some external irritation. A mode of ap- 
plying this which has been considered as peculiarly appropri- 
ate, is the nitro-muriatic acid bath: prepared by uni 
parts of nitric, to three parts of muriatic acid, and dilut 
the mixture with from tiftv to sixtv pints of water. The 
ture thus prepared is about as acid a> common vinegar, and is 
sufficiently Retire to produce slight prickling when applied to 
the skin. This bath was applied in Iudia, (where re- 
introduced,) to the whole surface by immersion: but it is suffi- 
cient to employ it as a foot bath, and at the same time tosponge 
with it the surface of the body. Employed locally to the 
gion of the liver, it may be o\ double the strength above di- 
rected ; the greatest inconvenience which can follow 
being a sort of rash upon the skin, attended with boom 
and a discoloration of the surface. We have introduced this 
mode of applying an external irritation as having been found 
especially useful in those countries where complaints oi the li- 
ver are most abundant ; but where the ma inBOt be con- 
veniently obtained, the more familiar mode* oi p ro duc in g the 
same effect may be resorted to, with much adv: 

Passage of Gall-stones. Gall-stone bodies of irreuularlv 
rounded form and brown colour, usually occurring in the 



PASSAGE OF GALL-STONES- 469 

bladder, though sometimes in the liver. They vary from the 
size of a mustard seed, to that of a pullet's egg. The texture 
is crystalline or lamellated. They are very light, and burn r 
when dry, with a bright flame, like wax. Their precise com- 
position has not been determined, but they are evidently formed 
from the bile itself, and contain the same constituent principles 
varied somewhat in their proportion. They have been met 
with sufficiently large to fill and distend the gall bladder much 
beyond its natural size; but even one of these dimensions oc- 
casionally makes its way through the tluct into the intestine, 
though this passage will not, in common, admit a crow quill. 

Gall-stones are more frequently found in women than in men, 
and appear to be generally connected with a life of repose and 
indolence. Sometimes they occasion very little disturbance to 
the system, and are found in considerable numbers after death,, 
without having been at all suspected during life. Dr. Heber- 
den mentions an instance of one weighing a quarter of an 
ounce, which remained during life withoutcausing any distur- 
bance. Where irritation is produced, the means adopted by 
nature for the removal of the obstruction are sometimes not a 
little remarkable. An abscess may form and open externally; 
and, what is more singular, recovery may follow. By a process 
which we cannot here explain, the body has made its way inta 
the intestine without having entered the duct. The latter, 
however, is the most frequent route, and it is its passage through 
this which constitutes the affection we now describe. 

We may suspect that a gall-stone is engaged in the duct of the 
gall bladder when violent pain occurs at the pit of the stomach, 
accompanied with sickness and vomiting, the pulse, mean while, 
remaining perfectly unchanged in character. We say suspect, 
for none but the most experienced practitioners, or those who 
have already passed concretions of this character, can distin- 
guish the attack decidedly from ordinary colic. There are 
two periods in the passage of a gall stone through the duct, 
at which the pain is supposed to be particularly severe. The 
first is, when the stone enters the canal, and the second when, 
quitting this, it passes into the cavity of the intestine. Between 
these, there is an interval of comparative ease. 

The alleged objects of treatment in these cases are to dimi- 
nish pain and to relax spasm. Perhaps we might with more 
propriety omit the last, for the nature of the peculiar action 
which urges forward the stone, is unknown to us ; and could 
we succeed in relaxing the parts concerned in it, we might pos- 
sibly prolong the suffering. Fortunately, nature seems to pro- 
vide for the ultimate success of the process, when it has once 
commenced, and leaves us charged with little else than the re- 



470 worms. 

lief of the immediate suffering. For this purpose, we employ 
bleeding, general and local, which maybe carried to the same 
extent as in other cases where the object is to afford immedi- 
ate remission of pain. After this it is usually recommended to 
use purgatives, which, if they produce a beneficial effect, must 
do so by favouring the efforts of nature to rid herself of the 
obstruction. When the bowels are freely evacuated, opium 
may be tried, and probably, in the severer cases, the latter will 
be found necessary immediately after bleeding. Warm fomen- 
tations to the skin, and a warm hath, are aUo recommended, 
and, on the whole, it will be seen that the treatment best adapt- 
ed to this purpose does not dilfer materially from that of com- 
mon colic, except in the absence of all nee r emetics 
and purgative injections; so that an error in the distinction 
between the two might be practically less important than would 
be at first supposed. The I : preventing the return 
of the attacks is to use free exercise, and obviate theordii 
causes oi dyspcpsB. 

fl'iT/ns. The mode in which worms come to be generated 
in the human body is a subject of ackno 
difficulty. Whether the embryo be produced in, or introduced into 
the canal, ami. if the latter, whether by the food, the water or 
the air, are qu< Quityofth 

but their consideration does not enter within lb 
It is sufficient to observe, that th s which are found in the 

inh stinal canal of the human subject have, in this, tic 
priate abode. They are not fou: it of the body, and, 

when expelled spontaneously or lv. 

Whether any animal, introduced into the - without, 

pt certain ian blingthel <»rm 

of sheep, can withstand tl n o( the gastric juice, and 

remain a tenant of its dark prison, may well —for 

the accounts of adders, toads, frogs, and other annua 
have been discharged alive from the rectum. . rdetl 

as mere fables, baring their origin \\ 
part of the patient, aided In pious fraud on that 
Dr. Elliotsen once saw two centipedes, said to have be 
ed by a girl twelve year \ had then been living tl 

days. Such case?, if they can he held as well establi? 
extremely rare. 

The principal varieties of worms peculiar to the human si 
ject are the long round worm resembling the earth worm, tin: 
ascarides or thread worms, and the several kinds of tape worm. 
The first and last are formed in the small iut 
in the stomach; the ascarides in the rectum, | 
tremity. The large round worm is too well known to i 



worms. 471 

any description. The tapeworm is so called from its flattened, 
form; it consists of long narrow joints; the head of some spe- 
cies terminates in a mouth, surrounded by two rows of hooks; 
the tail, in a semicircular joint, without any aperture. It reaches 
the length of thirty, forty, and even sixty feet ! It is gene- 
rally solitary, but sometimes collects in great numbers. The 
thread worm is about half an inch in length, and when thrown 
off, as. it usually is, in considerable quantity, resembles the cut 
ends of thread. A longer thread worm is found in the larger 
intestines of sickly children, but is much less common than the 
preceding; it is about two inches in length, and ditfers in seve- 
ral particulars from the last named animal. 

Worms are of such frequent occurrence in children, that ei- 
ther the round worm or the thread worm is supposed to ex- 
ist in fully one half their number, but it is probable that this 
calculation is greatly exaggerated. It is extremely difficult, 
without seeing the animals themselves, to decide on their pre- 
sence; as most of the symptoms which are supposed to be caused 
by them are common to other internal irritations. Among 
adults, one of the most certain causes of worms is the privation 
of salt as an article of food. The long round worms are much 
more frequently met with than any other variety, but it is by 
no means uncommon to sec the thread worms associated with 
them in great numbers ; and instances have occurred, in which 
all the varieties existed in the body at the same moment. Ge- 
nerally, the smaller the worms, the greater is their number. 

We are justified in suspecting the presence of stomach- 
worms, when a child of from two to ten years of age presents 
the following symptoms: — wasting of the body; swelled and 
hard belly; gnawing or pricking pain in the stomach; pale 
countenance; dirty hue of the skin; irritation of the nostrils, 
manifested by a constant desire to pick the nose; fetid breath; 
and sleep with eyelids half closed, disturbed by frequent 
startings. With the ascarides there is less evidence of gene- 
ral, and more of local irritation: there is usually troublesome 
itching about the arms, evinced by a disposition to rub the 
part; and sometimes, on examination, a swelling may be de- 
tected. Worms have been known to produce obstinate cough, 
and children have even been supposed to be consumptive, and 
treated accordingly, until accident has led to the discovery of 
the source of irritation. The indications to be fulfilled by the 
treatment are, first, to destroy the life of the animal; secondly, 
to expel it when dead; and, lastly, to correct those morbid 
states of the stomach and bowels, which render them a fit re- 
ceptacle for these troublesome parasites. 

Among the articles which have been relied on, for destroy- 
ing worms, we may mention the spigelia or pink-root. This 



472 worms. 

article is an acrid narcotic, and when given in too large doses, 
will produce symptoms of poisoning, such as dimness of sight, 
dizziness, retching, and even convulsions; but the medicine 
is very popular, both in the hands of regular and irregular 
practitioners, in the cure of that description of worms, which 
especially infest the stomach. The mode of administering it 
is to prepare an infusion of from a quarter of an ounce to an 
ounce of the root, according to the age of the patient, to give 
this in divided doses during one day, and, on the next, to work 
it off by a cathartic of senna. This plan often succeeds in 
bringing away large quantities of lumbrici, which are much 
more easily acted upon than the tape worm; but we think 
that the remedy should not be lightly employed by the inex- 
perienced. 

The next remedy which we shall mention, is the down of 
the dolichos jjruriens, or cowhage. The pods of this plant 
are covered with a hairy substance, which, applied to the skin, 
irritates and inflames it. We are told, that in Guiana, where 
the round worms are very abundant, it is the custom for the 
planters to administer this article to their negroes, and parti- 
cularly to the children, at least once a year. The dose is a 
tea-spoonful to a child, and double this quantity for an adult, 
in syrup or molasses: this is given in the morning, for three 
days successively, and followed up by a close of rhubarb. 
After the second dose, the patient 1 incredible quan- 

tity of worms, partly lumbrici, and in part the long thread 
worm. 

Notwithstanding the irritating character of the medicine, 
its spiculce are not found to affect the coats of the intestines, 
so as to occasion any inconvenience. The same article, in- 
volved carefully in thick mucilage, and introduced din 
into the lower bowels, is found to dislodge the asearides. 

A dose of calomel, proportioned to the age of the child, two 
grains for the first year, five grains after the fifth, adding a 
grain for ever}' succeeding year, until the twelfth, given at 
night, and followed by senna in the morning, will often suc- 
ceed in dislodging worms, especially lumbrici. from the i 
tinal canal. But this remedy should never be our first choice, 
unless the presence of some other disease require it 

A remedy which probably possesses a more decided con- 
trol over intestinal worms than any other article, is the oil, 
or spirit of turpentine. The good effects of this article appear 
not to be limited to any one form of the disease. Even the 
tape worm, which is insensible to the action of most other 
vermifuges, often yields to this. Turpentine is given in d 
of from half a tea-spoonful to an ounce, according to the 
of the patient. Though it would be madness in the unpr 



RHEUMATISM. 473 

sional adviser even to copy the example, it may be mentioned 
as a curious fact, that five or six ounces have been taken at 
once with decidedly good effects, by patients in despair with 
tape worm. When the object is to attack the small worms in 
the rectum, it may be thrown directly into tins part in quan- 
tities not differing* materially, from those above recommended 
by the mouth. When turpentine, given in the laiter mode, 
does not operate, it must be followed up by castor oil. 

The last vermifuge we shall mention, is common salt. This 
substance appears to dislodge every variety of intestinal 
worms, but it is chiefly employed in the treatment of asca- 
rides. A tolerably strong solution, thrown up as an injection, 
will speedily displace them. When, by any accident, this de- 
scription of worms have travelled upwards toward the sto- 
mach, draughts of the same mixture are peculiarly efficacious. 

In addition to the list above given, almost all the drastic 
cathartics have been pressed into the service, either as having 
power to dislodge the worms, or to remove the slime in which 
they burrow. 

With the exception of tenia, intestinal worms are usually 
expelled without serious difficulty. A more important mat- 
ter in the treatment of children, is so to regulate the state of 
the stomach, and improve its secretions, that these parasites 
shall no longer be able to find a resting-place. This may of- 
ten be effected by a well regulated, nutritious, and simple diet, 
in which sweetmeats, cakes, and butter, are, in a great degree, 
prohibited. 

If, by this means, the disorder can be kept within reasona- 
ble limits, time and the changes it usually effects, will gene- 
rally complete the cure. 

Worms have, sometimes, existed for a long time, without 
producing any inconvenience, and instances have happened, 
where persons have voided tape worms of considerable length, 
of whose presence, until the moment of expulsion, they had 
not the most remote idea. 



SECTION VI. 



Diseases of Fibrous Tissue. 

Rheumatism. The signs by which an attack of acute rheu- 
matism is commonly recognised, are pains in one or more of 
the larger joints, as the shoulder, hip, knee or loins, aggra- 
vated by motion, and by exposure to cold or dampness. 

60 



474 RHEUMATISM. 

Along; with inflammation in the joint, there is more or less 
pain in the course of the adjacent muscles, which is likewise 
increased, when these muscles are brought into action. The 
muscles are often swollen, and by compressing them with the 
hand, much uneasiness is caused. In the milder cases, it is 
remarked, that though motion of the parts affected causes pain, 
yet, if this motion be persevered in, the sensibility diminishes, 
and only returns after a period of repose; so that the attack 
may sometimes be wholly overcome by active exercise; a cir- 
cumstance peculiar to this form of inflammation. Another 
peculiarity of rheumatism is its disposition to shift from one 
joint, or set of muscles, to another. 

This transfer often takes place in consequence of the means 
adopted to relieve an affected part, as local warmth, for in- 
stance, in consequence of which, another is left comparatively 
defenceless. The surface of the affected parts is «flen unna- 
turally red, swoll . and tender; the joints of the hands 
and feet, when affected, are always so; but the larger joints 
sometimes retain their natural colour. In those who have 
once been affected, there is always reason to fear its recur- 
rence from slight causes, or without apparent cause. It rare- 
ly occurs in young children, and is most frequent from the 
twentieth to the thirty-fifth year. 

When rheumatism attacks the oral Deemed in breath- 

the pain is aggravated by full inspiration, and in t!. 
the disease makes an approach to pi means < ; 

tinction have been pointed out in our remarks on the latter 
disease. Generally speaking, the co-existence of rheumatic in- 
flammatk uttonal liability of the 

;it to this latter affection, will furnish a ru 
When the pericardium is affected, which, from it- '.rut- 

lure, it is liable to be, there urse, local pain and disor- 

dered action of the heart: this complication of rheumatu 
very con from da; times the dura 

: is attar bave delirium and other threatening 

symptoms. Much more frequently th« the 

external muse ,t the head. nded 

with peculiar The eye is not unfi 

of rheumatic affection. 

As rheumatism differs in its general course 1 in- 

flammation, so. many of the with 

benefit in the latter ai in the former. General I 

ing is seldom o\ permanent servi 
acute cases. Local bleeding h; 

the part primarily affected, but aj> Irana- 

fer to others ; and blisters are liable to tl. on : still. 

they are both necessary adjuvants in the treatment. The best 



^RHEUMATISM. 475 

remedies, unless there are circumstances which particularly 
direct attention to the stomach, are sudorifics. In fact, the ■ 
tendency of the disease to relieve itself by sweat, is often mani- 
fested throughout its course, though the energy of the system 
may not be sufficient to procure complete relief in this way. 
The sudorifics employed may be partial or general, external 
or internal. Local fomentations, with flannels wrung out of 
hot water, or of some anodyne infusion, will often be found ser- 
viceable. General sweating may be induced in various ways; 
such as fomenting the abdomen ; placing the patient in a 
warm bed, and having the feet, while thus covered, immersed in 
warm water; and the general warm bath. Among internal 
sudorifics, the most successful, perhaps, are the Dover's and 
James's powder, particularly the former, which may be taken 
in the dose of ten to fifteen grains at bed time. In the early 
stage of rheumatism, when unaccompanied with fever, pow- 
dered guiacum in the dose of a tea-spoonful, or the tincture in 
double this amount, is worth a trial. The latter may be swal- 
lowed in water or milk, but the mixture must not be allowed 
to stand, as the guiacum very quickly subsides. Sometimes 
this remedy acts like a charm, producing an agreeable sensa- 
tion of general warmth, and relieving the disease in a few 
hours. Like the remedies above mentioned, it should be taken 
in bed. 

Another remedy which has acquired a reputation in rheu- 
matism, is the seed or the root of the meadow saffron. Its use 
requires caution. We shall again refer to it under the head 
of gout. 

The duration of acute rheumatism, if not relieved within the 
first twenty-four hours, is very uncertain. It often wanders from 
joint to joint, for eighteen, twelve, or more days. This migratory 
state, however, is favourable, as no part becomes seriously af- 
fected ; but whenever it fixes itself somewhat pertinaciously in 
a single joint, there is reason to fear permanent lameness of 
that joint, constituting the chronic form of the disease. In this 
form it is of indefinite duration ; remitting its severity from time 
to time, but never wholly quitting the unfortunate member. 
The chest is rarely affected with chronic rheumatism; its prin- 
cipal seats are the loins, hip, and knee. The joint, except 
during the occasional exacerbations, is not either swollen or 
red, but cold and stiff, and is always relieved by local warmth. 
In the remissions of pain, it often becomes greatly debilitated, 
and the limb is rendered useless. 

If the hip is the seat of the disease, the joint, from disuse 
and inflammation, may become permanently stiffened, so that 
the motion of the thigh upon the leg isdost. If the loins are 
affected, a similar result may occur; the spine is then habitual- 



476 gout. 

ly bent, and, in this position, a thickening of the fibrous part-', 
or an actual union of the bones takes place. 

v In this form of the disease, besides the remedies already 
mentioned, as guiacum, Dover's powder, colchicum, &c, vari- 
ous external applications, of comparatively little service in the 
acute disease, may be employed with advantage. Friction with 
the liniment of ammonia, a cataplasm of mustard, or a bli 
will often afford relief; a current of steam may be directed 
upon the part, or electricity may be tried. 

The most remarkable, however, of these local means is a 
practice which has been introduced into use within a l> 
under the name of acupuncturation. It originated in the i 
where it lias been practised from time immemorial, especially 
in the Celestial Empire. It consists in the verv slow introduc- 
tion, by a boring motion, of one or more needles to the depth 
of an inch or more into the inflamed part, and allowing them 

main from rive to six minutes. Little pain is produ 
and no bleeding follows. At the end of this time the pain will 
he found to ha d in the part, and perhap 

ferrcd to another; if the same operation be performed 00 the 
latter, it will often atirelv. Thflfl 

calculate amr parti, and cannot be 

pected to suet ncture, or stillness of a 

joint, has taken place. 

Gout has its immediate seat in the small joints of to 
mities, and especially in those of the feet. Th 
occurrence, however, in a large proportion t 
to be a certain morbid state ot the stomach, and of the di 
tivc system generally. The subjects in whom it mo^t us 
shows itself, are those of sanguine temperament, of full habit, 
florid complexion, and rather coan rsonsof rath 

dentarv, indolent i Life, and who, perhaps, ' be- 

ing intemperate, indulf in the p of the t 

It is more common in cities than in the country, in men than 
in women, in those using principally animal food than in I 
restricted t<> vegetable diet From hereditary | re I - 
however, and otln ; not well understood, persons 

different habits are included among it-; viet'. 

Gout commonly mai . with pain in the ball i t 

the great toe, and with a 1 ml chill. As the pain 

increases, this chill gi- . and the usual symp- 

toms of fever. The joint soon bee; ilea, red, 

tense, the redness disappearing win 
and returning when the pr - removed. The 

of pain and inflammation continues perhaps with 
meat for 0! hours. At length, probably on the o 
that of the attack, it begins to subside, and terminating 



gout. 477 

a gentle sweat, leaves the patient to the enjoyment of repose. 
For several days the symptoms recur in the evening, though 
perhaps in a more tolerable form ; and then subside, leaving 
the foot apparently sound, and the system in a state of increased 
health and vigour. 

After the first fit, especially if the alarm of the patient in- 
duce him to reform his mode of life, the disease often absents 
itself for three or four years; then, generally on the occasion 
of some excess or imprudence, such as exposure, cold, severe 
bodily labour, mental application, or, in a word, any distur- 
bance of the system, the attack is renewed : at each return, the 
interval is usually shortened, while, on the contrary, the dura- 
tion of the fit is augmented ; and, instead of subsiding in three or 
four days, it will at length continue, with occasional remissions, 
for as many weeks. From the prolongation of the fits and the 
contraction of the intervals, the affection sometimes becomes 
almost constant, so that the patient scarcely ever enjoys good 
health. 

As the disease advances the symptoms are modified. At first 
the paroxysm appears without warning; afterward, it is preceded 
by a sense of coldness of the lower limbs; occasional pricking, al- 
ternating with numbness ; slight shiverings ; disturbance of the 
stomach, &c. At first,only a single joint is affected. Then the two 
feet are attacked in succession, the pain commencing in one as it 
subsides in the other. Then, perhaps, both are affected at once 
or alternately. At last, the other joints become involved, and the 
disease becomes universal, or nearly so; but the intensity of the 
pain diminishes, so that although there be no freedom from it 
at any time, the patient is able to give some attention to his 
ordinary occupations, even during the paroxysms. 

Some permanent traces of the attacks are soon visible in 
the principal joints, which become swollen, stiff, and weak- 
ened, so that walking is performed with more and more diffi- 
culty. Mean while, the small joints of the toes and fingers 
are embarrassed by a whitish deposite, once supposed to be 
actually chalky, and still so called in popular language; .but, 
in fact, consisting of the acids of the urine in combination 
with soda. Such quantities of this deposite sometimes accu- 
mulate, that an individual is mentioned who used in playing 
cards to score the points of the game on the table with his 
knuckles. 

It is a general impression that gout, when it becomes ha- 
bitual, absorbs all the morbid tendencies of the system, and 
keeps all other diseases at a distance. However this may be, 
it is worthy of remark, that individuals severely affected with 
it continue to an advanced age, often transcending the ordinary- 
bounds of human existence. When gout proves fatal, it is gene- 



478 gout. 

rally by receding, as it is termed; that is, by suddenly quitti-ng 
the extremities, while the stomach, the brain, or some other 
important organ, becomes the seat of inflammation. 

.On the means of preventing the attacks of this disease lit- 
tle need be said, after the enumeration of its remote causes. 
" Live on sixpence a day, and earn it," was the brief answer 
given by the eccentric Abernethy, to one who questioned him 
how he should escape; and probably no advice could have 
been more judicious. It has often been remarked, that per- 
sons who, after being in comfortable circumstances, were com- 
pelled by a change of times to labour for their sustenance, 
have been entirely cured by this reverse. Active exercise, 
combined with temperance, will sometimes check even the 
hereditary tendency to gout. 

It would be wrong to conclude that an attack of gout is al- 
ways a certificate of luxury, wealth, or indulgence. We have 
repeatedly met with it among the poor, and in the abstemious, 
both by choice and necessity; in old soldiers, washerwomen, 
shoe-blacks, sailors, seams' d temperate farmers. 

An empirical medicine, regarded as specific in this disease, 
has long been in use under the title of Hussou's eau medici- 
nal. Its immediate effect is to produce abundant evacuation 
from the bowels, of course increasing greatly the secretions 
from the whole surface of the intestinal canal. Whether this 
be or be not the true explanation, certain it is that the article 
alluded to has the power to shorten the paroxysm of gout. A 
similar power is possessed by the meadow saffron; which is 
generally thought to be the active article in the nostrum just 
mentioned. 

It is now hardly to be doubted that these remedies act by 
producing counter-irritation on the bowels, and diminishing the 
inflammation by profuse discharges. They are ver. 
drastic pu . and their action must be carefully watched. 

Their hyper-action brings on cramps in the bowels, and 
lieial cholera; which, if tl> ;ed on princi- 

ples already laid down. Their virtues are - 
solelv in the veratrine which they contain; but as th:^ 
ble principle, when pure, is exceedingly dangerous in other 
than experienced hands, the vinous tinctures of the 
and root of the colchicum, though variable in power and - 
injured by light and time, are considered th- 
the class. Of the former, the full dose is thirty, and of the 
latter, ten drops, three times a day: inci lie former by- 

ten, and the latter by four drops per diem, until some pain in 
the bowels is produced, or until the doses have reached sixty and 
twenty drops respectively; but omitting the article instantly 
on the occurrence of any unpleasant symptom. When 



CHOREA, OR ST. VITlTs's DANCE. 479 

the medicine is supplied from a new parcel, we should re-com- 
mence with the first doses; for the strength of the preparation 
is always uncertain: and it is only in the absence of medical 
advice, that such articles should be exhibited bv the inexperi- 
enced. 

When gout strikes in upon the stomach, head, or heart, 
every external means should be employed, to provoke its 
return by stimulation. While the former organ is attacked, the 
patient for a few minutes is often apparently dying. In this 
case, a little wine or brandy should be given internally, and 
it is well to follow it, when the paroxysm is over, by half an 
ounce of the compound tincture of aloes. 

That class of patients who are doomed to expiate the vices, 
or suffer the reflection of the misfortunes of their progenitors, 
often discard all violent remedies, provide themselves with pa- 
tience, carbonate of soda, and flannel; and endure their appointed 
purgatory with a calmness and patience, which it is not easy,with 
eut some actual experience of the suffering, duly to appreciate, 



SECTION VIi. 

Nervous Diseases. 

Chorea, or St. Vitus' 's Dance, is more common in females than 
in males, and usually occurs in children from eight to fourteen 
years of age. The procursive symptoms are variable appe- 
tite, sometimes ravenous and sometimes wanting, a degree of 
listlessness and inactivity, a swelling and hardness of the belly, 
usually accompanied with constipation, 'and slight, irregular 
convulsive motions of the muscles of the face. As the disease 
advances, the muscles of the extremities, of the lower jaw, the 
head, and the trunk, are in various degrees affected. In this 
state the patient is unable to walk steadily, his only movement 
being a kind of jumping or springing; or, perhaps, he is com- 
pelled to run in order to make any progress. To whatever 
set of muscles it is attempted to communicate motion, these im- 
mediately become affected with the diseased action, and either 
refuse to obey the will, or obey it imperfectly, and by jerks in 
uncertain directions. Even if speech be attempted, articula- 
tion is found impossible, or the words are uttered with embar- 
rassment and difficulty. In the progress of the disease, the eye 
loses its brightness and intelligence, and the countenance be- 
comes pale and vacant. In some cases actual loss of mental 
power seems to follow. 

The whole muscular system is never simultaneously affected: 



480 SHAKING PALSY. 

and, in some instances, the perfect control which is retained 
over a part, compared with the mutinous state of the remain- 
der, is very remarkable : sometimes, though the gesticulations 
are most absurd, the speech is easy and fluent; and sometimes, 
when unable to walk with any approach to regularity, the pa- 
tient can sing and play with the most perfect correctness. 

The predisposing cause of this disease is undoubtedly debility, 
generally dependent upon too rapid growth. The approach of 
puberty has been considered a predisposing cause of chorea; and 
so far as the changes then effected are causes of general weak- 
ness, the idea maybe correct; but their farther influence may 
well be doubted. In boys, however, sexual excitement, and 
particularly certain criminal indulgences, not uncommon at 
this age, should be suspected, when symptoms of chorea begin 
to manifest themselves. The too frequent use of vegetables, 
and the presence of worms, are also regarded as common 
causes. 

The treatment of chorea, in its advanced entirely 

beyond the reach of the domestic practitioner; and all that he 
can properly attempt, even at the to remove all the 

remote causes of the disease above enumerated, to establish a 
regular system of light, but nutritious diet, to administer some 
of the milder vegetable tonic teas, and leave the rest to nature 
and fresh air. 

Shaking />«/>•// is distinguished from chorea by appearing 
principally in persona advanced in life: and by the tremu- 
lous action being nearly constant, and not called forth or 
mented by attempt at voluntary motion. Shaking pa 
marked by a tremulous motion of the whole head which is not 
characteristic of chorea. To palsy, properly so called, the 
malady in question has but a remote resemblance: the s 
bility remains unimpaired, and the control over the mu 
though diminished cely ever wholly 1 

The approach of the die jadual, that si 

or ten months elapse before any material inconvenience occurs, 
except a disposition to bend the body forward in walking. At 
length, the legs begin I led, and locomotion is accom- 

plished with more difficulty. When the patient attempts to 
advance, he finds himself thrown upon his toes, and is compelled 
to adopt a running gait, in order to prevent himself from fall- 
ing forward. In a still later stage, the tremulous motions lake 
place during sleep, and awaken him suddenly in gn 
tion. The power o( conveying the food to the mouth, and of 
swallowing it when taken, are as much impaired as ii 
Vitus's dance. As a fatal termination approaches, the dis 
assumes more of the character of real palsy. Tlu 
muscles of the neck gradually lose their i that the 



CONVULSIONS EP1LEPSV. 481 

chin rests on the chest; the power of articulation is lost; and 
at length the control ceases even over the natural evacuations. 
In this form the disease is peculiar to old age, and to the in- 
temperate. It seems to be beyond the reach of medicine. 

A peculiar affection, called the gilder's tremor, occurs in 
those who have been exposed to the fumes of quicksilver. The 
first symptom is unsteadiness of the arms, which, gradually in- 
creasing, extends itself to other parts of the body, and renders 
it impossible for the patient to walk, to speak, or even to chew. 
If the employment be persevered in, loss of memory, sleepless- 
ness and delirium ensue. But if the occupation be abandoned, 
the disease generally proves curable. 

Convulsions are marked by such a variety of symptoms as to 
make it difficult to embrace them in any general description. 
What may be considered common to all, however, is an irregu- 
lar spasmodic action of some of the muscles,, while others are for- 
cibly contracted. The sensibility is impaired or lost, and the 
power of utterance suspended. It is said that in the convul- 
sion fit the two kinds of spasm, the rigid and agitative, are 
about in equal proportion, while in epilepsy the latter, and in 
hysterics the former predominate. As epilepsy and hysteria 
constitute the most severe forms in which convulsion shows it- 
self, we shall offer a brief description of each; while our cura- 
tive remarks will be principally directed to the milder and 
more manageable forms, which depend rather on accidental 
causes than on peculiarity of constitution. 

In Epilepsy, the person attacked loses suddenly all sense 
and power of motion; so that, if standing, he falls immediate- 
ly, or is thrown by convulsion, to the ground. In that situa- 
tion he is attacked with violent spasms, variously moving his 
limbs and the trunk of the body. Commonly the limbs on one 
side are much more violently affected than those on the other. 
In all cases the muscles of the eyes are especially agitated, so 
that the lids open and shut in perpetual motion, or are stretched 
in a full stare, while' the eyeballs are rolled rapidly in every 
direction. The muscles are alternately rigid and relaxed, the 
mouth foams, the tongue is forcibly protruded, and often bitten 
by the spasms which affect the under jaw ; the whole face is 
hideously distorted, and frequently of a deep purple. The 
muscular power developed during the paroxysm is enormous, 
so that the strength of five or six persons is required to restrain 
the struggles. These fits frequently commence with a violent 
scream : their ordinary termination is in sleep. They recur upon 
almost any occasion of bodily or mental excitement, and often 
without any assignable cause. The disease is frequently he- 
reditarv. The paroxysms generally commence from the age 

61 



482 HYSTERIA. 

of fifteen to twenty-five years, and when the habit is once 
formed, it is fortunate for the patient if they do not continue 
through life. If incurable, they terminate sooner or later in 
madness or idiotcy. 

Hysteria most generally occurs in females, between fifteen 
and thirty years of age. The fit commences with a coldness 
and shivering over the whole body, a quick but fluttering pulse, 
and an acute pain in the head. Some pain is also felt in the 
belly, generally on the left side; from this a ball seems to move 
with a grumbling noise through the abdomen; thence, after va- 
rious evolution?, it rises into the stomach and then into the 
throat, where it, seems to remain for some time, and, by is 
pressure on the larynx, to cause a feeling of suffocation. This 
sensation is peculiarly characteristic of this affection. To this 
succeed stupor, insensibility, and convulsions. The trunk of 
the body tosses to and fro, the limbs arc variously agitated, 
the hands are firmly clenched, and the breast is often violently 
beaten. Sometimes there is a singular combination of sobbing, 
crying, laughing, and shrieking, in the midst of the fit, and 
sometimes obstinate hiccough. The insensibility in hi 
r'.a is usually incomplete, the patient having some conscious- 
ness of what i< croinrr on around her. After alternate r« 
sions and exacerbations, the convuls Be entirely, and are 

succeeded by a state of lethargic Bleep. More* klen- 

ly, and frequently after rep g and sobbing, th< 

tient returns to consciousness, with no other feeling of incon- 
venience than perhaps a Blight pain and a general -citation 
of sorene eria is not usually hereditary, and is far less 

likely to be followed by serious coi - than epilog 

Convulsions from occidental and transient causes, pre- 
sent for the most part those symptoms which are common to 
the above described d: atcr 

resemblance to epilepsy, from which they differ princi; 
in being less violent, and in the absence of the cree 
sation, that precedes the attack of the latter. these 

accidental varieties, however, some deserve particular men- 
tion; as the infantile cam ually induced by surfeit or 
by the irritation of teething; those of children, produced 1 
milar causes, or appearing as precursors or con-equences of 
eruptive fevers; those manifested during child-birth: and, 1 
those arising from loss of blood. Convulsions also appeal 
symptoms or concomitants of other P worms, hy- 
drocephalus, and gastric or intestinal in;' - on; are > 
times induced by constipation, and sometimes by affections of 
the mind. 

The first object in the treatment of these accidental convul- 
sions is, to attack the remote cause; this indication, however, can 
seldom be answered, except in the infantile convulsion, and in 



CATALEPSY. 483 

(hat of labour. In these, the necessity for this kind of relief 
is often imperious; for, though the immediate fit may termi- 
nate spontaneously, it will continue to recur as long as the 
cause of offence continues.. In the case of tits from surfeit in 
children, the cause must be removed by an emetic. In that 
from teething, the gum which causes the irritation must be 
lanced; and in the puerperal variety, under certain conditions, 
delivery must be effected. But we also possess direct means 
for lessening the violence of the spasmodic action and abridging 
its duration; and these may be employed where no reference 
can be had to the remote cause. Of this class is bleeding, 
which is peculiarly necessary in the puerpernl form, and may 
with safety be resorted to in adults, whenever there is evi- 
dence of plethora or vascular fulness. In children, bleeding 
is seldom needed ; a warm bath, with friction to the extremi- 
ties, will generally subdue the spasm. At all ages, what are 
called the antispasmodics deserve a trial, since, if they do no 
good, there is little danger of injury from their use. Such are 
ammonia, camphor, and valerian, the advantage of which can 
be combined byiadding to the ammoniatcd tincture of valerian 
an equal quantity of a saturated solution of camphor in alco- 
hol; and administering the compound in doses of twenty to fif- 
ty drops. In cases where the cause seems to be merely ner- 
vous irritability, and it is an object to prevent the formation of 
an injurious habit, the sudden application of cold, by dashing 
cold water over the head, will sometimes not only terminate 
the fit, but prevent its recurrence. It is, however, a harsh re- 
medy, and if it fail at one trial, it will be a useless cruelty to re- 
peat it. 

We have said nothing of the special treatment of epilepsy 
and hysteria, because there is always time and opportunity 
enough for medical consultation in these diseases. On emer- 
gencies, the practice recommended above may be safely insti- 
tuted. 

Catalepsy or Trance is characterized by the abolition of 
sense and voluntary motion, the breathing and pulse continu- 
ing, and the body, trunk, and limbs receiving and retaining 
any position which may be communicated to them. It most 
usually occurs in females of nervous temperament, but from 
what exciting causes is not known. The disease is, without 
question, often feigned, but it also occurs under circumstances 
which wholly forbid the idea of deception. The state of 
trance commences without previous warning, and generally 
terminates with sighing. The duration is very various, the 
fit, in some instances, continuing only a few hours, or even 
minutes, and in others, lasting whole days. The breathing is 
extremely feeble, and sometimes the pulse wholly impercep- 



464 APOPLEXY. 

tible, so that persons in this state have been supposed to be 
actually dead. 

Attacks somewhat similar to trance, have been known to 
occur to persons while walking, and in these instances, though 
consciousness was lost, the motion was continued, so that 
the state approached very closely to that of somnambulism. 
The disease is rare, and is not amenable to medical treatment, 
except of a general character. There are some instances on 
record, in which accidental bleeding has proved critical. One 
is that of a young girl, who became cataleptic at ten years of 
age, the paroxysms recurring at shorter and shorter intervals, 
and resisting all medicines. In one of these attacks the girl 
dashed her head against a sharp stone, and a profuse hemor- 
rhage ensued. The bleeding not only put an end to the fit, 
but prevented its return. 

•Apoplexy. A sudden and general loss of sense and motion, 
with slow breathing and pulse, the inspiration often attended 
with a snoring sound, constitute apoplexy. It is to be distin- 
guished from palsy, because, in this last, the loss of motion is 
partial only, and the functions of the senses, with the excep- 
tion of the general feeling of the part attacked, though im- 
paired, are not suspended. 

Apoplexy generally occurs in persons with short necks, and 
large heads, who have passed sixty years of age, who are 
more or less inclined to coipulence, and who unite great men- 
tal application with bodily inactivity and a liberal indulgence 
of the appetite. Intemperance in drinking is generally re- 
garded as a cause; and, no doubt, confirmed sots often die of 
apoplexy: but it is equally proved by experience, as remarked 
by Dr. Cheyne, that the daily use ot wine or spirits will lead 
a man of a certain age and constitution, to apoplexy, as cer- 
tainly as habitual intoxication. ( - - also frequently occur 
in spare old men, of great bodily activity and temperate ha- 
bits; so that no kind of constitution can be regarded is 
empt. 

Among the occasional causes, may be mentioned violent 
exercise, especially when combined with exposure to the sun; 
exposure to a warm and impure atmosphere, such as is pro- 
duced by the collection of large numbers of persons in a con- 
fined space; excess in drinking; the presence of undig* 
food; long stooping or hanging of the head: a ligature or tight 
cravat about the neck; and violent mental emotion. 

The proximate cause of apoplexy, or the state of system 
which produces it, is probably pressure upon the brain, at the 
origin of the nerves, which proceed from it. This pressure 
may be the effect of a tumour within the cavity of the skull; 
of effusion of blood, or serum; or simply of unusual fulness 



APOPLEXY. 485 

of the cerebral veins. That the first and second are causes of 
apoplexy, has been shown by the examination of those who 
have died of this disease, and the last appears highly probable 
from the nature of the remote causes, and the mode of the at- 
tack. 

In the paroxysm of apoplexy, the patient should, if possi- 
ble, be carried into a cool apartment, of large size and well 
ventilated. He should be placed in bed or on a sofa, but with 
the head considerably raised. 

All unnecessary company should be excluded, and all un- 
necessary conversation prevented. 

It is probable, indeed, that in genuine apoplexy, all con- 
sciousness of what is passing around is suspended; but the na- 
ture of the case may not be such as suspected, and the patient, 
though unable to express himself, may be fully aware of the 
import of the expressions used by others. All portions of 
dress, which encumber or bind the person, especially ligatures 
about the neck, should be removed; the feet should be im- 
mersed in warm water, and the legs rubbed with stimulant 
applications. 

When the movements show that nausea is present, when 
the attack follows immediately on a meal, or when there \» 
any strong reason to suspect the presence of indigestible food 
in the stomach, an emetic should be immediately given, with- 
out regard to the increased pressure on the brain, produced, 
for the moment, by the action of the remedy, which pressure 
is less likely to occur in apoplexy, than in most other dis- 
eases, because the abdominal and thoracic muscles are pre- 
vented by their torpidity, from taking their usual very active 
part in the process of vomiting. They leave the effort main- 
ly to the stomach itself, and hence, the blood in the thoracic 
and portal vessels is not forced out mechanically, which is the 
mode by which all the other blood vessels, and those of the 
head among the number, are distended in ordinary vomiting. 
Unfortunately, it is often extremely difficult to rouse the sto- 
mach to action in apoplexy; and although medical men pos- 
sess many very powerful and prompt emetics, the only one 
which we can conscientiously recommend, on emergency, to 
the domestic practitioner, in the cases under notice, is thirty 
grains of ipecacuanha, with two grains of tartar emetic, given 
in a little sirup or molasses. 

If an emetic operation be obtained, it should be followed by 
the administration of a powerful cathartic, which may be aid- 
ed in its operation by a stimulant enema. As the object is 
to produce a prompt effect, the cathartic should be chosen 
with reference to this property. Perhaps the most conve- 
nient and effective article, for this purpose, is the croton oil, 



486 



APOPLEXY. 



in doses of one drop diffused in water or milk. This may be 
repeated every two hours, until an effect is obtained. Mean 
while, active friction, with Cayenne pepper, or other stimu- 
lating substances, mustard cataplasms to the feet and legs, and 
external warmth, wherever the temperature is reduced below 
its natural standard, will be useful auxiliaries. 

There is a popular, but ill-founded notion, that bleeding is 
a specific in the treatment of apoplexy. That it is generally 
advisable is certain: but it is equally certain that there are 
many cases of exception. The populace, and, with them, the 
unreasoning and less informed of the profession, have run wild 
in favour of a favourite remedy; and, us usual, partisans of an 
opposite extreme in opinion have recently arisen. Some mo- 
dern physiologists, remembering but a few of the predicates of 
the problem, have concluded that the quantity of blood in the 
head cannot be either increased or diminished by any cir- 
cumstances whatever. Hence, say they, bleeding can have 
no effect in lessening the pressure of blood upon the brain! 
Not one of the postulates upon which this doctrine is founded 
is physically true; and the lemma engrafted upon It is an ex- 
quisite non sequitur! 

As these opinions have received the sanction of men of 
high note in the profession, who have unfortunately d 
garded the first principles of hydrostatics in their physiologi- 
cal reasoning, we think it light to enter our protest against 
the hypothetical objections to the use of the lancet in the 
treatment of apoplexy. But let it be distinctly understood, 
that the remedy must be used with all the precautions ob- 
served in its employment in other diseu 

When there is no strong reason to suspect that distention 
or irritation of the stomach has caused or exacerbated the at- 
tack, there is no temptation to employ an emetic; but whether 
this remedy be prescribed or not, if the patient be not an ha- 
bitual toper, if he have no previous disease of great debility, 
if the face be flushed or purple, and the pulse slow and ex- 
tremely feeble or irregular, a vein in the arm should be 
opened with a large orifice, and the patient bled freely, and 
as rapidly as possible, until the pulse is decidedly diminished 
in force, or increased in frequency: but where the face is pale, 
marking a violent revulsion from the surface, or when the 
constitution has been previously broken down by disease, or 
when the pulse is feeble and fluttering, and death impend 
we must depend exclusively upon the counter-irritants and 
other adjuvant remedies already prescribed. If a pulse, at first 
weak, should, as it sometimes will, acquire additional force 
during the progress of bleeding, the flow must not be checked 
until the force of the circulation again declines. 



PALSY. 487 

Palsy. Apoplexy, when not immediately fatal, is apt to 
terminate in a state in which the power of motion, and usually, 
the sensibility of one side of the body is lost, and the powers 
of the mind, especially the memory, impaired'. This state 
constitutes one form of palsy, and is termed hemiplegia. In 
these cases there is every reason to believe that the affection 
or accident in the brain, on which the apoplexy depended, is 
of a nature to remain permanently, or for a considerable time. 
It is worthy of observation, that, when palsy proves fatal, it 
does so by again passing into the state of apoplexy. In a 
few cases, hemiplegia occurs without any preceding apoplexy. 
These cases sometimes originate from exposure to the sun, 
drinking cold water when heated, repelled eruptions, &c. 
Sometimes an intimation is given of the approach of the at- 
tack by pain in the head, a difficulty of moving the ton<me, 
and the loss of perception and of memory. But the attack 
itself is sudden; so that the patient, if standing upright, drops 
clown upon the affected side. 

In paraplegia^ which is another variety of palsy, the loss 
of power and sensibility is confined to the lower part of the 
body. This disease is often dependent on injury of the spine 
or the nerves of organic life; but often comes on without any 
known cause. At first there is a slight numbness in the low- 
er limbs, with a stiffness or awkwardness in moving the mus- 
cles. By degrees these symptoms increase; there is great 
difficulty in walking, and inability to preserve the balance, so 
that the aid of a staff or the arm of an assistant is needed. At 
first the bowels are costive, but at length the discharges are 
made involuntarily. The disease may continue for years, but 
the patient sinks at last from general exhaustion. Recovery 
is rare. 

Local palsy occurs most freqently in the muscles, about the 
angle of the mouth, but may also affect the eye, the cheeks, a 
hand, an arm, &c. It may originate from disease of the brain, 
the spine, the bowels, or even from the wound of a nervous 
fibre. We have known it to occur severely in the face, from 
the irritation of small fragments of the sockets of extracted 
teeth. It it sometimes the precursor of a more serious attack, 
either apoplectic or paralytic, and, therefore, a most dangerous 
symptom; at others it marks important disorders in the nerves 
of the abdomen, as when seen in painter's, colic : and some- 
times it is transient and free from danger, as when it follows 
the extraction of a tooth. 

In the onset of hemiplegic affection, we may pursue the 
treatment fitted for apoplexy, except that it would be madness 
to exhibit emetics here, unless in cases of poisoning, which oc- 
casionally produces this form of paralysis, though very rarely. 



488 DROPSY. 

In paraplegia the spinal marrow is generally the seat of the 
principal mischief; and this form is often occasioned by poi- 
sons. Emetics are then our main dependence in the com- 
mencement. 

The seat of partial palsy is so difficult to determine in most 
cases, that unless symptomatic of some of the diseases already 
described, we would seriously advise the intelligent domestic 
observer, to regulate the diet and habit of the patient on cor- 
rect hygienic principles, and then to leave the case entirely to 
nature. 

There appears no sufficient apology for touching upon the 
after treatment of palsy in the present work. It is a difficult 
business, requires no particular promptitude, and professional 
advice on the subject may always be obtained in time for all 
useful purposes. 



SECTION VIII. 



Prominent Symptoms, and Accidejits. 



Dropsy. — The immediate cause of dropsy is an undue accu- 
mulation of fluid, either in the cellular substance which inter- 
venes between the skin and the muscular tissue, or in the se- 
rous cavities. 

The quantity of effused fluid, in either of the situations just 
referred to, is dependent upon two opposite processes, — depo- 
sition and absorption. It is evident that either an augmenta- 
tion of the former, or a diminution of the latter, would be 
adequate lo tne production of the disease. Accordingly, it has 
always been a subject of discussion, whether dropsy should 
be considered an active or a passive affection; whether the 
capillaries should be considered in fault for separating too 
much, or the absorbents for taking up too little. The dispute 
is much like that regarding the colour of the camelion, and 
7ce leave the intelligent reader to decide it. 

Cellular Dropsy generally shows itself in the lower limbs, 
where it is marked by a cold diffused swelling, which, when 
pressed, leaves a pit or impression of the fingers for some time. 
It may be either a symptom of some internal effusion, or a 
distinct affection. In either event, however, the progren 
slow. The swelling appears first about the feet and ankles, 
and is more or less observable through the day, disappearing 
or being much diminished during the night by the recumbent 



DROPSY. 489 

posture. By degrees it becomes more permanent, ascends 
higher, affects the legs and thighs, and finally, may even reach 
the trunk and face, which last, becomes pale and bloated. If the 
disease advance, the skin of the legs gives way, and the accu- 
mulated fluid either collects in sacs under the cuticle, or 
oozes out in drops. 

Other symptoms, common to this and other forms of dropsy, 
when not the result of simple debility, are general inactivity, 
costive bowels, constant thirst, urine deficient in quantity 
and of deep colour, a failure of the appetite, and emaciation. 

In hydrothorax, or dropsy of the chest, the fluid is accumu- 
lated in the cavity of the pleura. The peculiar symptoms are 
a sense of oppression in the chest; difficulty of breathing on ex- 
ercise or on lying down; livid countenance, irregular pulse, and 
palpitation. 

These appearances, however, are deceptive, and unless fluc- 
tuation, of which we shall speak presently, can be perceived, 
the existence of water in the chest is scarcely to be distin- 
guished with certainty from other affections. 

When the disease takes the form of ascites, or dropsy of the 
abdomen, the water is usually contained in the peritoneal ca- 
vity; and its presence is readily recognised by the sense of fluc- 
tuation which is produced when one hand is placed on one 
side of the belly, and the opposite side is gently struck or 
tapped with the other. This form of dropsy is often compli- 
cated with more or less disease of the liver. The quantity of 
fluid collected has been, in many instances, surprisingly great. 
Twelve gallons and a half have been discharged through an 
artificial opening at onetime. The symptoms, with the excep- 
tion of the gradual swelling of the belly, which cannot fail to 
be remarked, resemble very closely those of hydrothorax; but 
there is less embarrassment of breathing. 

The three forms of dropsy which have been mentioned, es- 
pecially the first and last, are very frequently united, and arise, 
from causes in many respects similar. They form the sequel 
to fevers and inflammatory affections, especially of the pleura 
and the peritoneum, and are often among the signs of the decay 
of constitutions impaired by early excesses, by exposure to 
varying influences of climate, and by hard labour. 

The treatment is chiefly directed to two objects, the evacu- 
ation of the effused fluid, and the prevention of its return. Jn 
cases of anasarca and ascites, direct means of evacuation are 
afforded by surgery. In the former case, scarifications made 
with a lancet through the tumid integuments will permit the 
effused fluid to escape; and in the latter a more complete eva- 
cuation may be effected by tapping. But as these means are 
palliative merely, they are now never employed, except under 

G2 



4D0 HYDROCEPHALUS. 

urgent necessity. To cause the evacuation of the superfluous 
fluid through the natural channels, emetics, sudorifics and blis- 
ters, have been often resorted to ; but the principal remedies 
employed have been, first, the drastic cathartics, which, from 
their peculiar operation, have been termed hydragogues, and 
which produce abundant liquid evacuations from the alimen- 
tary canal; and secondly, the diuretic class, which cause a 
like tendency of the fluid to the urinary passages. The parti- 
cular remedies of both classes are numerous; but we must be 
content with adverting to the principle on which they act. It 
is no part of our purpose to encourage the domestic practi- 
tioner in their employment. The re-accumulation is prevented 
by whatever has a tendency to strengthen the constitution and 
increase the vigour of the absorbent system ; and hence tonics, 
especially the vegetable bitters and the preparations of iron, 
have always been considered as among the best. Dropsy, and 
especially that of the feet, when the result of simple debility, 
as is often the case after rapid growth in children, long conti- 
nued convalescence, &.c, will often recover gradually without 
aid. The tonics are properly administered in protracted cases 
of this character. 

We have reserved for a separate consideration three forms 
of dropsy, in many respects differing from the foregoing, both 
in their causes and their course; two of which have this cir- 
cumstance in common, that they are often congenital, and even 
exist previously to birth; and, the third, as coming within the 
domain of surgery, will require only a passing notice. 

Water in the Brain forms a frequent termination of that pe- 
culiar disease in children, to which the name of hydrocephalus 
is applied, but in which, frequently, neither the symptoms du- 
ring life, nor dissection after death, countenance the idea of any 
elTusion whatever. As, however, the name must be retained, 
and as the true dropsy of the brain is for the most part an in- 
fantile affection, it will be most convenient to treat of both 
forms of a flection under a single head, distinguishing as far 
as possible the symptoms peculiar to each. 

Inflammatory hydrocephalus, though sometimes found in 
adults, is mostly limited to the first seven years of life. The 
commencing symptoms are those of irritation generally, and 
very similar to those produced by worms. Such are irregu- 
larity of bowels, and especially costiveness, listlessness, impa- 
tience, knitting the brows into a frown, a sense of weight in 
the head, which the patient is constantly desirous of resting 
upon a chair; irregular fever, and sometimes pain shooting 
through the head from temple to temple; accompanied, per- 
haps, with sickness at stomach. The vivacity and good-hu- 
mour proper to childhood are lost: the eye becomes- dull. 



DROPSY OF THE HEAD. 491 

ihe cheek pale, with occasional irregular flushes. The child 
walks infirmly, and even staggers. The pulse is quick, but 
irregular, the sleep interrupted and uneasy, and the eye as- 
sumes an oblique or squinting appearance. The pupil, which 
is at first contracted, at length dilates, and is no longer affected 
by light. There are paroxysms of fever, generally coming on 
towards evening, but sometimes irregular in their appearance. 
The head is felt to be hot, and severe pains are complained of 
in the forehead. The approach of the fatal termination, is 
marked by wild and sudden screams; irregular contraction and 
dilatation of the pupils; throwing back of the head, delirium, vo- 
miting and convulsions. 

In many instances, on examination, a certain amount of fluids 
varying from a iew tea-spoonsful to eight or ten ounces, has 
been found in the brain. This effusion, however, is not to be 
considered so much the cause of death as an evidence of the 
extent to which the inflammatory action has proceeded, and 
which would be sufficient to destroy life whether effusion took 
place or not 

The duration of the disease varies: commonly it runs on 
from three to six weeks; but it may prove fatal in a fortnight, 
or even in two or three days. When it extends beyond six 
weeks, it is to be regarded as chronic; and, in this form., 
may go on even for years. 

From the difficulty of distinguishing this disease, with cer- 
tainty, in its earlier stage, it has been made a question whether 
a genuine case has ever recovered. This view is, perhaps, too 
discouraging; but it seems to be admitted on all hands, that 
the time for action is at the outset, and that if the disease be 
neglected or misunderstood in its earlier stages, the chance of 
recovery is exceedingly small. 

The remedies employed in this disease are mostly those 
adapted to active inflammation generally, and consist of local 
bleeding, the application of cold to the head, and mercurial 
purgatives. The two former should be used freely and fear- 
lessly, and the calomel has been urged to the extent of pro- 
ducing salivation with the most happy results. Of course, 
nothing but dire necessity would induce a domestic practi- 
tioner to charge himself with the treatment of this affection. 

In the true dropsy of the head the whole course of symp- 
toms is of a milder and less violent character. It not unfre- 
-quently commences antecedently to birth, and the head of the 
infant is then found already enlarged. The accumulation has 
been known to amount to five pounds of fluid. This disease 
often shows itself some months, or even two or three years, 
^fter birth. As it proceeds the head very gradually enlarges? 

• For farther details, see Diseases of Children, (Chap, iv.) 



492 HEART-BURN. 

and the bones are separated from each other. Sometimes a 
small, distinct tumour appears at the top of the head, which 
increases for a time, and then declines, being finally merged 
in the general swelling. 

Cases occasionally happen in which the disease, after reach- 
ing this stage, passes into a chronic form, and the subject lives 
to manhood with no other inconvenience but that arising from 
the deformity and weight of the head itself. In other cases, 
this protracted form is accompanied with occasional at- 
tacks of convulsions, under which the patient at last sinks, 
after having reached the age of twenty or even thirty^ years. 
In others, again, the fluid is apparently absorbed, and the con- 
stitution finally triumphs. We are told of one instance in 
which this favourable change took place under the influence 
of mercurial medicine. Here the disease commenced at the 
age of four years, and increased for six months, at the end of 
which time the head was as large as that of an adult. After 
the treatment was instituted, the scull ceased to augment, and 
the intellect gradually brightened. At twenty, the individual 
was in full possession of his health and faculties, with a head 
scarcely larger than it had been fourteen years previous. 

In this form of dropsy the head has frequently been punc- 
tured, and the effused fluid allowed to escape. This opera- 
tion has generally been attended with relief; and, in some in- 
stances, has effected a cure of the disease. The most satisfac- 
tory account of the result of this operation, is one published 
by Dr. Conquest, of London. Dr. C. operated on nine c 
in four of which he was entirely successful. 

Heart-burn. This affection is characterized by a peculiar 
burning sensation at the pit of the stomach, accompanied usu- 
ally with eructation of an acid liquid. It comes on from one 
to two hours after taking food, and the acid, which is identi- 
cal with vinegar, is evidently generated during the process of 
digestion. The immediate cause of heart-burn, therefore, is 
derangement or imperfection of the digestive process; and 
this again arises partly from the debility of the stomach itself, 
and partly from the introduction of crude and unyielding ar- 
ticles of diet. It occurs particularly in those who have im- 
paired the tone of the stomach by the alternate use of very cold 
and very hot beverages; who have indulged freely in spiritu- 
ous or fermented liquors; who have long been subjected to the in- 
fluence of tropical climates, or who have accustomed them- 
selves to powerful cathartics. The article of food which, as 
neral rule, is most likely to produce it. is animal oil or fat. in the 
form of rich meats, gravies, drawn butter, toasted cheese. 
Pastry, in all its forms, is one of the most efficient means of 
inducing heart-burn. Next to these arc to be ranked those 



WATER-BRASH — FLATULENCE. 493 

culinary compounds which are composed of flour, eggs, sugar, 
and various other ingredients combined; and which are far- 
ther prepared for the process of digestion by the addition 
of hot sauces. Next come cakes of various kinds, and most 
of the results of the confectionary art ; and fully equal to these 
in their power to generate acid, are all rich and oily nuts. In 
enfeebled stomachs, however, and those peculiarly prone to 
the complaint, nine-tenths of the ordinary articles of food be- 
come exciting causes. Butter, sugar, fruit, vegetables of all 
kinds, (excepting, perhaps, a potato,) and even bread itself, are 
viewed with distrust! till a morsel of dried meat, a soda bis- 
cuit, and a little brandy and water, constitute the sum total of 
the luxuries of the table. 

Water-brush, so called, differs from heart-burn in this, that 
the eructation is generally in greater quantity, and is wholly 
destitute of taste. It is most apt to occur early in the morn- 
ing, and at other times when the stomach is empty. It seems 
to be connected, more peculiarly than the other, with a relaxed 
state of the fibres of the stomach, brought on by indulgence in 
spirituous potations, and more particularly perhaps in malt li- 
quors; but it sometimes affects temperate persons from causes 
similar to those of common heart-burn. It is often accompa- 
nied with a sensation of faintness. 

Relief is afforded, during the paroxysms of heart-burn, by 
the use of alkaline substances, such as magnesia, chalk, and 
ammonia, which neutralize the acid. The compound formed 
by the magnesia is cathartic, and that by the chalk, astringent; 
so that the choice between them is determined by the costive 
or lax condition of the bowels. Other articles proposed appear 
to have a direct effect in sheathing the gastric membrane from 
acrimony. Such is the case with oil, and especially with soap, 
which is probably decomposed, its alkali being seized upon by 
the acid, while its oil serves the purpose above mentioned. 
These remedies are merely palliative and temporary; and oil 
is objectionable as being one of the very articles which pro- 
duce the affection. A far better plan consists in avoiding those 
articles which are found to disagree with the patient; but were 
this plan rigidly pursued, and every such article positively dis- 
carded when found to produce acidity, the stomach would soon 
be found in some cases irritable from exhaustion, and the pa- 
tient in danger from mere inanition ! It is highly necessary, 
therefore, in both the affections we have been considering, to 
impart vigour to the organ by tonics, &c. The remedies and 
regimen adapted to this end will be considered under the head 
of dyspepsia. 

Flatulence is another of the annoyances to which feeble 
stomachs are subject. It consists in the extrication from the 



494 FLATULENCE — CGSTIVENESS. 

food of large quantities of gas, principally the carbonic acid, 
which is sometimes eructed, sometimes passes downwards, or 
may remain pent up in the cavity, producing a rambling noise 
and more or less uneasy sensation, though seldom actual pain. 
This gas is the product of fermentation; and this process, which 
is prevented when digestion takes place in a healthy manner, 
here goes on under the combined operation of heat and mois- 
ture, as if the vital influence were checked or withdrawn. When 
the quantity of gas thus separated is large, and finds no natu- 
ral outlet, the abdomen becomes sometimes great)} swelled, and 
tense like a drum. 

There is a class of remedies called carminatives, supposed to 
act primarily on the mucous membrane, and. by sympathy, on 
the muscular fibre of the stomach, so as to enable it to expel 
its contents, and in a degree to resist distention, when a new 
supply of gas comes to be produced. Familiar - 
seen in the seeds of the caraway and cardamom, the aniseed and 
coriander, the leaves or calv\< - ;nint, 

thyme, etc., also in ginger, and the aromati- Bat it is 

still to be remembered thai th< •-• 
their repetition, instead of 1 to impair the 

roach. It might be supposed that 
tic taken with, or immedi. J, would pr 

this affection ; and the f thi^ pi j 

extent, is proved by the beneficial 
means of effecting the principal ration of i 

i the stomach, by which i( 
remains yet to be considered under the b i; but 

We cannot resist the temptation to mention ' 
ral of the most obstinal under our no- 

tice, recovered speedily and perfectly under the us 
mon table salt, given dry. in 
times a day. 

Costivencss. Afl ral rule i( 

nance of perfect health, that th< 
in twenty-four hours, livery deviation, t! 
condition, though not a ground for alarm, should be at 
regarded with distrust. Among tfa 

to produce this deviation are sudden changes of diet, such as 
a change from on< ig principally g to one 

in which animal food has the I 
from a le<s pure to a purer art 

Dated with saline ingredients, to one destitute oi them: cl 
of air, as that oi the plain for the mountain. — the land for 

: (but in this I; >ther circumstances usual! 

rate to produce the effect;) also change ot hah m a 

less, to a more sedentary occupatioi I [fenta which, p 



COSTIVENESS. 495 

out impairing the general health or appetite, compel the indi- 
vidual to almost absolute repose, nearly always 4 produce con- 
stipation. Any circumstance which induces inattention to the 
regular evacuation, or which makes constant attention inconve- 
nient, will have the same effect. The immediate, proximate 
cause of the change in these cases is not easily discovered, but 
in a few particular cases may readily be conjectured. Thus, 
the costiveness which belongs to convalescence from long con- 
tinued disease, is the natural result of the activity with which 
absorption is carried on for the supply of the system, and which 
leaves the residuum wholly deprived of its fluid portions, and 
in a state which renders its expulsion difficult. The costive- 
ness of jaundice is also easy to be explained ; for here no bile 
finds its way into the canal, and its fibres are not moved to 
their natural and healthy action. 

Some of the means, by which the bowels may be relieved 
from a state of costiveness, have been anticipated in speaking 
of the causes by which the state in question is induced. The 
articles of food which have obviously had an influence in 
causing the complaint must be omitted ; and a diet principally 
vegetable, with a moderate use of fresh fruit when in season, 
may be substituted therefor. Of the materials commonly em- 
ployed in making bread, the flour of Indian or rye meal is more 
opening than that of wheat, and the latter is rendered more 
so by being combined with the husk or bran, which is usually 
separated from it by the process of bolting. Together with an 
appropriate selection of articles of diet, a due share of bodily 
activity is highly important; and of all kinds of exercise, pro- 
bably the best adapted to promote the evacuations, is walking. 
The effect of exercise on horseback, and in carriages, is, in 
many persons, entirely opposite, — for reasons of which, we free- 
ly confess our total ignorance. 

Among the mechanical aids for promoting regular evacua- 
tions, there is one which has attracted much notice within a few 
years, though by no means of modern suggestion; — that of 
kneading or shampooing the belly. This may be easily prac- 
tised by the patient upon himself, and thus the double pur- 
pose, of exercise and of mechanical pressure, is answered. 

Of the medicinal articles, commonly employed to relieve 
constipation, the list is sufficiently long; and the very variety 
and number of those in common use, serve to show how very 
unsatisfactory are the results derived from them all, when 
their use is depended on as a substitute for the natural and 
spontaneous actions of the system. 

In choosing medicines for habitual constipation, regard 
seems to have been had principally to the convenience of the 
form, and the smallness of the bulk, in which they could be 



496 COSTIVENESS. 

administered. Hence the preference for the drastic purges, 
so called ; such as aloes, jalap, scammony, gamboge, &c. These,, 
with calomel and rhubarb, form the materials of nearly all the 
popular cathartic pills, whose composition has become known. 
These nostrums are not ordinarily open to the objection that 
they purge violently or produce pain: the general difficulty 
in their use is, that they create more trouble than they re- 
lieve. Their operation is followed by increased torpor, for 
which an augmented dose is needed: from one or two pills, 
'the patient proceeds to ten or twelve, to fifteen or twenty; 
till finally, the amount necessary to produce the effect desired 
becomes absolutely enormous. With all this, no immediate or 
violent effects are manifested; but the digestion, instead of im- 
proving, becomes more and more deranged, the appetite is 
lost, and the stomach becomes the seat of sub-acute inflamma- 
tion, which sooner or later, if the treatment is persisted in, 
closes in death. Such is not an uncommon termination of 
the habitual and excessive use of cathartics.- Such a habit 
should never be formed, if it be possible to avoid it. If there 
be any mode in which articles of this description can be per- 
severed in without injury to the system, it is by combining 
them with the food itself, in such a manner as to supply, in 
some measure, its defective stimulating power. A small piece 
of the root of rhubarb, after a meal, chewed and mingled with 
the saliva, will often answer this purpose in a very effectual 
manner. 

In most persons, calomel, instead of losing its effect by use, 
actually acquires force by habitual employment, and is, there- 
fore, exceedingly well fitted for some forms of costiveness. 
To be useful in this way, it must be given alone; for in all its 
combinations with other purgatives, it loses the property 
above mentioned ; a result which also follows, if it be given 
in doses unnecessarily large; and this fact we would strong- 
ly impress upon our western readers, among whom the 
abuse of calomel is carried to a most shocking extent, even 
by some professional men. The plea that decidedly larger 
doses are required, in consequence of the peculiarities of the 
climate, is absurd, when reference is made to countries within 
the temperate zone. We have practised in tropical countries, 
where large doses are really required; but even there, they 
bore no proportion to the enormous quantities usually given 
in the West. We have practised in the West, and our chief 
occupation was the removal of the bad consequences of large 
doses of calomel, by the proper employment of smaller ones! 

In the habitual costiveness of middle-aged and elderly fe- 
males, marked by too light a colour of the stools, we have 
never failed in breaking the habit by the following means. 



INDIGESTION OR DYSPEPSIA. 107 

though we have attacked cases of thirty years' standing, in 
persons aged from sixty to seventy-five years. 

Let the patient take five grains of calomel at bed-time. If 
it do not produce a free stool by ten o'clock next morning, 
increase the dose to eight grains, and if it produce more than 
two stools, diminish the quantity to three grains. Let the 
medicine be given every other night, until it begins to pro- 
duce more than two stools. Then omit it until costiveness 
returns. On this return, commence with the last dose, and 
continue till more than two stools are again produced. Then 
omit, and proceed as before. After a time, if the habit prove 
obstinate, the calomel will frequently produce four or five 
stools when given in doses of a single grain! but usually the 
habit is broken before the quantity requires to be diminished 
below three grains — which is the quantity commonly re- 
quired from the first. Always diminish the dose whenever 
the first exhibition brings on three or more evacuations, and 
increase it if no discharge follow; but when the increased 
quantity also fails, it is safest to administer some stronger pur- 
gative, such as senna, or rhubarb, and jalap, omitting the mer- 
cury for three or four days, when the larger quantity may be 
tried again. 

Under this course of treatment, if advantageous, the inter- 
vals between the returns of costiveness, though, at first, en- 
during but two or three days, are soon elongated to a week, 
a month, and many months. We thus treated an old lady of 
seventy-five, and childish, who for more than forty years, had 
but one stool per week. The remedy was administered at 
seven intervals. She has been perfectly regular for several 
years. 

Indigestion or Dyspepsia. That state of the stomach, in 
which it is incapable of performing its appropriate function, 
of changing the received food into chyme, is termed dyspep- 
sia. Some of the effects and concomitants of this state, and 
the means of relieving them, have been already touched upon, 
under other heads; but the more general consideration of the 
affection has been reserved for this. Whether the immediate 
cause of dyspepsia is to be sought in the debility of the mus- 
cular fibre of the organ, or, in the defect or bad character of 
its secretions, is a question not easily determined in all cases. 
There is little doubt, however, that both causes usually, coex- 
ist; the tendency of the food to the acetous fermentation seems 
to be the effect of the latter; while the tendency to distention, 
and the difficulty with which the aliment is urged forward 
into the intestines, is a proof of the former. Other symptoms 
of dyspepsia, besides those already alluded to, are oppression 
at the stomach after food is taken; a sense of weight and drag- 

63 



498 INDIGESTION OR DYSPEPSIA. 

ging about the limbs, while the digestive process is going on? 
a sensation of gnawing rather than hunger felt whenever the 
stomach is empty ; a disposition to sleep after meals, which, 
when a full repast has been taken, is almost irresistible; and 
frequently a heavy dull pain about the head. The modes in 
which indigestion is induced, are nearly innumerable; and as 
almost all of them may be inferred by the intelligent, from 
the* principles and facts contained in the chapter on Hygiene, 
we shall not dwell upon them at present; but one very uni- 
versal cause demands the especial attention of Americans; 
namely; the habit of too rapidly swallowing food, by which 
sufficient time is not allowed for the process of mastication, 
and for the secretion of the fluids which aid digestion. 

The general means by which dyspepsia may be avoided, 
are to be inferred from the nature of the causes by which it 
is induced. But its cure requires other considerations, for it 
is not always that even a bad habit can be wholly omitted 
with impunity, nor will its discontinuance always repair the 
mischief which its indulgence has occasioned. As respects 
intemperance in the quantity, and variety in the kind of food, 
the principle of sudden reformation may safely be practised; 
and those accustomed to bolt their aliment without taking 
time for mastication, will find no inconvenience in adopting 
more civilized customs. The regulation of the mind and the 
due control of the passions also require no caution. 

But the change from sedentary to active habits is one of 
more difficulty. The sedentary student may be fully per- 
suaded of the advantages of exercise, and may, with all ear- 
nestness, attempt a reform ; but if the exercise be tedious or dis- 
tasteful; if he walk without an object or interest, merely to 
accomplish a task, and with his mind still occupied by his 
previous studies, he will gain little benefit. Exercise must 
he an actual relaxation and amusement, or it will fail in pro- 
ducing its effect. It is on this ground that travelling, which 
combines bodily motion with a change of scene and pur- 
suit, is so often recommended. Exercise should produce 
fatigue, but not exhaustion. The indigestion arising from ar- 
dent spirits can be cured only by abandoning their use, and 
substituting therefor some of the bitter tonics, to which al- 
lusion will presently be made. That from coffee can general- 
ly be obviated by the substitution of tea; and that from the 
use of green tea by the use of black; which produces, usually, 
little disturbance, either of the stomach or the nervous system. 
Opium, in every form, must be totally abstained from. To- 
obviate the cravings occasioned by its disuse, the bitter tinc- 
tures which contain a narcotic principle, such as those of vale- 
rian, hops, &c.j may be employed. 



INDIGESTION OR DYSPEPSIA. 499 

The remedial measures for giving tone lo the stomach, and 
for improving the character of the secretions, are, in general, 
those, which are termed tonics. They are supposed to exert 
their action on the muscular fibre. They are generally bitter 
substances, and are employed either in their simple state, or 
in the form of tincture. Of the propriety of employing these 
spirituous preparations, there has been no little question 
among the advocates for total abstinence from all distilled li- 
quor. But it is at least certain, that the injurious effect of the 
spirit is very considerably modified by the addition of the 
bitter principle, and that this is generally borne better by the 
stomach, when first submitted to the action of its appropriate 
solvents. Among the most popular of these preparations may 
be mentioned Huxham's, or the compound tincture of bark, 
which, in addition to its principal ingredient, contains snake- 
root, saffron, orange peel, (fee. 

Whatever virtue the above articles may possess in their cha- 
racter of tonics, they are still to be regarded as subordinate to 
those more general means which communicate vigour to the 
stomach by strengthening the whole system. Such are the 
breathing of fresh, pure air; the due exercise of the muscular 
system ; cold and warm bathing ; and the maintainance of a 
well regulated mind and a cheerful temper. 

In connexion with the subject of indigestion, it may not be 
useless to suggest some brief remarks in the choice of articles 
of diet, and the regulation of meals. In making these, we are 
not ignorant of the ridicule which attaches to such precepts 
delivered without regard to the constitution and circumstances 
of the individuals addressed. We are aware that it is impos- 
sible to frame rules of living which shall apply at once to the 
hardy and robust denizen of the country, labouring with his 
own hands, and eating his bread, literally in the sweat of 
his brow, and to the pampered and indolent son of fortune sur- 
rounded by luxuries which he has lost the power to enjoy. Still 
there is a large class to whom sound maxims of dietetics will 
apply, and for whom they will possess interest. We allude to 
that portion of the inhabitants of cities and towns, whose oc- 
cupation is continued from necessity through eight, ten, twelve 
or more hours each day, and is not of a nature to bring into 
exercise the larger and more powerful muscles; in other words, 
persons of sedentary or stationary employments, fixed to one 
sphere and to one kind of labour, whether this consist in wri- 
ting for the press, settling accounts, setting types, regulating 
watches, mending shoes, or attending to millinery or mantua 
making. Such persons constitute, perhaps, one-fourth of the 
adult population of towns. What proportion of them actually 
suffer from indigestion, we are unable to conjecture ; but we 



500 RULES OF DIET. 

are well convinced that, in a very large number, the functions 
of the stomach arc performed in a manner far from satisfac- 
tory. All these persons have an interest in the general prin- 
ciples of dietetics, and however diversified their condition and 
circumstances, these principles admit of a ready and simple 
application to all. We shall offer then, for the especial be- 
nefit of these persons, some few remarks on diet, the choice of 
food, and the regulation of meals. 

One substantial meal of animal food is sufficient for the daily 
supply of a man in health, engaged in business involving ordi- 
nary labour. The custom, therefore, of taking meat for break- 
fast, and again at supper, is perfectly unnecessary and un- 
questionably pernicious. The principal meal should be taken 
about one^ or two o'clock, so as to occupy about the middle of 
the waking period. The animal food should consist of one 
dish only, and that, of easy digestion. Fish, and particularly 
shell-fish, disagree with some weak stomachs, and are apt to 
occasion an eruption upon the skin. Yet where they sit easily 
and are relished, several of them, particularly the crab and 
lobster, are found to neutralize acid in the stomach, better 
than any other description of animal food. The oyster also 
forms an exception to the general character of this class, being, 
when simply cooked, of extremely easy digestion. Of meats, the 
perfectly healthy kinds, among which the choice is nearly indif- 
ferent, or may be determined by individual experience, are beet, 
roasted or broiled, mutton, lamb, or venison. Of poultry, chick- 
ens, roasted or boiled, are among the least objectionable: of 
fresh fish, most descriptions, boiled or broiled, with the excep- 
tion of salmon, which is too rich. Of vegetables, rice and potatoes 
are the lightest and most nutritious. Peas, beans, and squashes 
can be indulged in by most with impunity ; and the tomato 
possesses properties which render it, for a relish, as salutary as 
it is grateful. Among those viands usually introduced, which 
are to be received with distrust, are the salted meats, gene- 
rally; as ham, salted beef, pork, etc. These are objectionable 
on account of the fat they contain and the form in which it is 
presented; but, in small quantities, and particularly with the 
aid of some condimeut,such as mustard, or horse-radish, they are 
borne well. Fresh pork, whether young or old, is unwhole- 
some to all but hard-working men. The flesh of goose is oily, 
and its nutritive qualities not easily extracted, except by a 
strong stomach. Many meats, however, which are too rich 
to be eaten alone, are improved by combination with the cruder 
vegetables, and by the addition of acids and other stimulants. 
Thus, salad, and even cucumbers, when dressed, assist the diges- 
tion of ham or pork ; and, on the same principle, a goose may be 
disposed of with the aid of that well known sauce which is 



RULES OF DIET. 501 

obtained by boiling apples in cider. Of such combinations, 
however, the dyspeptic, unless experience has taught him their 
adaptation to his own particular system, will be wary; and 
will rather depend on what he knows to be wholesome, than 
hazard his comfort by any rash exposure. 

Among culinary vegetables, the turnip disposes to flatulence; 
a fact equally true of the onion, but this vegetable possesses 
valuable properties which establish its claims to extensive use. 
The beet, the carrot, and the ruta baga, have the same fault 
as the turnip, besides possessing a saccharine principle which 
is apt to be converted into acid. The class of preparations 
termed puddings, have not found much favour in the eyes of 
the learned ; and probably, no one of the tribe has been more 
generally denounced than the 'dumpling; yet the experiments of 
Dr. Beaumont go to show, that neither beef nor mutton is so soon 
disposed of by the human stomach as this same dumpling. We 
mention this, not to 'encourage the imprudence of eating them, 
but to show that the rapidity with which an article is digested 
in a strong stomach is no proof whatever of its fitness for a 
weak one. According to Beaumont's experiments, a dish of 
tripe, some boiled salt codfish, with raw cabbage and vinegar, 
should form the favourite repast of the philosophic. Experi- 
ence, however, does not justify these conclusions, true as respects 
a single individual, but not capable of universal application. 
It is due to the learning and good sense of Dr. B. to acquit him 
of intending to found general rules on these particular re- 
sults. 

Articles, perfectly wholesome in themselves, may become 
objectionable from the form in which they are taken. This 
observation applies to minced dishes — no very tempting prepa- 
tions — and to jellies, which are generally considered as peculi- 
arly fitted for the invalid, from the facility with which they 
are swallowed. If taken without mastication, they make no 
impression on the salivary glands, and entering the stomach un- 
mixed with the secretions of these organs, are digested with 
difficulty. 

Water is of course the best of beverages. The best substi- 
tute, when water is found to encourage the formation of acidity 
in dyspeptics, is perhaps a little tea, of moderate strength, 
taken after, not during the meal. 

For the morning and evening meals, custom has so fully 
established the use of coffee and of tea, that any attempt at in- 
terference would be hopeless. It may be useful, however, in 
order to determine a choice in doubtful cases, to allude to 
some of the circumstances by which their respective effects 
are found to differ from each other. As a general rule, coffee 
acts more especially on the digestive, and tea upon the ner- 



502 VOMITING. 

vous system. Coffee, to most persons, is laxative; and it is 
this effect, the absence of which is missed when its use is first 
abandoned for that of tea or other liquids. Coffee, in any 
quantity, is apt to be followed, in persons of weak digestion, 
by. a peculiar sensation of sinking and faintness at the pit of 
the stomach, occurring about two hours after the meal is taken, 
and lasting, perhaps, for the same period. It is usually 
most marked in warm weather, and is accompanied by a dis- 
tressing sense of debility and relaxation. It somewhat resem- 
bles the sensation of hunger, and is sometimes relieved by swal- 
lowing some light farinaceous substance. Both coffee and tea 
produce wakefulness; but the latter is more certainly followed 
by this effect. In most persons, tea, especially when taken 
towards evening, produces a brightening of the intellect, and 
an agreeable sensation of gayety and cheerfulness, which do 
not belong, in the same degree, to the use of coffee. An occa- 
sional change from one to the other, is better than a long con- 
tinued perseverance in either. 

Among the usual substitutes for coffee, as a morning meal, 
may be mentioned milk and chocolate. A sudden change to 
either, will probably produce heaviness and headach, which 
are rather to be attributed to the absence of the usual stimu- 
lant, than to the presence of any principle in these articles 
themselves. If persevered in, either will at length be found 
nutritious and digestible. To this rule there are some excep- 
tions in persons otherwise healthy, but in whom one or other 
of these articles is always followed by unpleasant effects. For 
weak stomachs, the shells of the cocoa may be advantageously 
substituted for chocolate. 

Butter, as an addition to bread, is equally grateful and salu- 
tary; but the enormous quantities which are used by some 
persons, at each of the three meals, are decidedly injurious, 
often producing nausea, and sometimes serious disturbance. 

Vomiting. — The act of vomiting, when spontaneous, is fre- 
quently a salutary effort, on the part of the stomach, to rid it- 
self of an offending substance. It is often also artificially and 
intentionally excited. Under neither of these circumstances, 
can it be regarded as a disease, unless, in the one case, it con- 
tinues after the cause is removed, or in the other, passes the 
bounds by which its beneficial operation is limited. 

There are, however, some other varieties of morbid vomit- 
ing. Sea-sickness may be considered as one; for although 
the tendency of this may generally be to health, it often pro- 
ceeds to an extent which makes remedial measures necessary. 
The vomiting from inflammation of the stomach, is another 
morbid variety; and there are many individuals in whom, 
from habits or peculiarity of constitution, vomiting occurs 



VOMITING. 503 

upon very slight occasions, or without apparent cause, and 
continues until active measures are adopted for its relief. 

Excessive vomiting, after a surfeit, or entire evacuation 6f 
the organ, may often be relieved by the simple expedient of 
taking some light nutriment in a liquid form, rendered grate- 
ful by the addition of spicy, aromatic ingredients, such as 
arrow root, for example, with nutmeg and wine added. If this 
be rejected, a little green tea will perhaps be retained: if the 
vomiting continue obstinate, it may be necessary to adminis- 
ter a cathartic injection. These means seldom fail in accom- 
plishing the end proposed. 

When the vomiting from an emetic threatens to prove ob- 
stinate, it is usual to give a draught of the infusion of chamo- 
mile, or some aromatic herb, as balm, mint, sage, &c, which 
usually succeeds in arresting it. Should this not answer, a 
few drops of laudanum may be given, either alone or in com- 
bination with a carminative tincture. Sometimes the evolu- 
tion of carbonic acid gas in the stomach, by a draught of soda 
water, is found effectual; and sometimes a few drops of a bitter 
tincture, particularly the Columbo root, has been successful. 
Vomiting from emetics, unless they have been given in ex- 
cessive and unreasonable doses, very rarely escapes the con- 
trol of these and sintilar remedies. 

Sea-sickness is generally regarded as a self-limiting disease; 
and it is certainly true that it rarely proves fatal. But it is 
often exceedingly desirable to abridge the duration of this dis- 
tressing affection, especially in feeble subjects, and those ex- 
hausted by previous disease. The healthy and vigorous, pro- 
vided they can command resolution to resist its influence, and 
to exert their muscles in the open air, soon overcome it. 
Where this expedient cannot be resorted to, or fails, a little 
hot brandy, or Jamaica spirit and water, will sometimes serve 
to settle the stomach; and some nourishment, in a liquid form 
should be tried as early as possible. But a most powerful 
remedy for sea-sickness, — one that will often control it after se- 
veral days have elapsed, and other means have failed, — is a 
strong tea of horsemint, (monarda punctata) given cold, in the 
dose of a wine-glassful, every hour. 

Some of the most obstinate cases of vomiting occur in de- 
bilitated habits, and especially in those who have destroyed the 
tone of the stomach by the constant use of opium or alcohol. 
Such persons are in the habit of subduing slighter attacks of 
nausea by a resort to their favourite sedative; till, at length; 
the irritability of the digestive organs become so highly exalt- 
ed, that these means prove wholly unavailing, and the stomach 
obstinately refuses to receive the slightest portion of food ef- 



504 HICCOUGH. 

ther solid or fluid. These attacks are, in the habitual drunk- 
ard, sometimes of a salutary character; the liver assumes un- 
wonted activity, the bile is secreted in great abundance, and 
the system undergoes a thorough renovation. Frequently, when 
the vomiting ceases, or is checked, in such cases, inflammatory 
disease or the delirium peculiar to drunkards at once succeeds, 
and we are justified in supposing that these affections are in 
many instances prevented, in others rendered milder, by the pro- 
cess in question. The propriety of arresting it, therefore, when 
occurring in such subjects, might be questioned ; but decide as 
we may, its arrest is rarely within the ordinary resources of 
art. It will almost invariably run its course. These attacks 
may sometimes be checked without much hazard, by employ- 
ing the vegetable bitters; the chamomile and worm-wood have 
been particularly recommended. A blister applied to the re- 
gion of the stomach is another appropriate remedy. 

Inflammation of the stomach may be suspected, when, to ob- 
stinate vomiting, continued for many days in succession and 
recurring after apparent relief, great tenderness at the pit of 
the stomach is added. In some of these cases, the patient, 
though tormented with intense thirst, dares not swallow the 
slightest portion of liquid; and yet total abstinence itself af- 
fords but a partial and imperfect relief; for an empty retching 
torments the sufferer, when nothing is introduced into the or- 
gan from without. These cases require, in some respects, the 
ordinary treatment of inflammation in general; but their ma- 
nagement demands the highest order of medical skill, and can- 
not be discussed in a popular work. 

Hiccough. Although hiccough has its immediate seat in 
the diaphragm or midriff, it is seldom or never dependent on 
disease of that organ, but almost always arises from irritation 
in some other part, and especially in the stomach. It may be 
induced by mere distention of this organ ; as in infants, in whom 
the disorder is very common, from over-nursing. The presence 
of flatulence is a very frequent cause of hiccough : as is also 
the irritation produced by worms. Other causes, more distant 
or more general, will occasionally excite it, as disorder of the 
liver, and the irritation produced by strangulated hernia. Last- 
ly, it is among the signs, and, in certain cases, the surest sign 
of approaching dissolution. 

Although hiccough generally disappears with the cause which 
gave rise to it, it is, like other spasmodic affections, very de- 
pendent upon habit, and, hence, not only liable to recur upon 
slight occasions, but, when present, to go on obstinately at in- 
tervals of a few seconds, until it becomes a serious inconveni- 
ence. 

Hiccough may usually be checked by forcibly holding the 



HICCOUGH CRAMP. 505 

breath : and it is also a familiar fact that any sudden emotion, 
especially of fear or surprise, which powerfully arrests the at- 
tention, will have the same effect. This principle is often ren- 
dered available, in a familiar way ; but its operation was pro- 
bably never more effectually displayed than in the case of a 
young girl in Paris, who had been tormented almost constantly 
for six months, and who was brought to the hospital under the 
charge of Dupuytren. After trying the warm bath, and some 
other remedies to no purpose, the Baron ordered a red hot iron 
to be applied to the pit of the stomach, on which the spasms 
immediately ceased. 

When the complaint occurs in severe diseases, it sometimes 
requires vigorous treatment as a symptom, but the application 
of the necessary measures must be left exclusively to the pro- 
fession. 

Cramp. The precise nature of the influence which the 
brain ordinarily exercises over the voluntary muscles is not 
known ; but the fact is obvious that by the mere exercise of 
volition we are able to contract these muscles, and by so doing 
to communicate motion to the parts to which they are attached. 
In a state of health these muscles, if not acted on by the will, 
remain quiescent; but in various morbid states of either of these 
organs, the nerves of organic life, the spine, or the brain itself, 
this exclusive control is lost; and the muscle may contract, not 
only without any exercise of volition, but in defiance of the 
will. These deviations from healthy action are, in general, 
termed spasms; and these may be either constrictive, when the 
affected muscle is fixed rigidly until a counteracting force or 
another spasm produces relaxation; or clonic, when the affected 
part is made to move in short irregular twitches. Under the 
head of constrictive spasm are included some of the severest 
diseases to which the human system is subjected ; but the affec- 
tion at present under notice, though often exquisitely painful, 
is seldom dangerous. 

The most usual seats of cramp are the calves of the legs, 
the neck and the stomach. In regard to affections of the last 
organ, it cannot with propriety be said that the control of the 
will is withdrawn, since in fact the organ is not usually subject 
to this control; the disease here consists in the substitution, for 
the ordinary and healthy peristaltic actions of the fibres, others 
which are irregular and unhealthy. The cramp which attacks 
the legs usually occurs in the night, when the limbs by long 
rest have become stiffened. Cramp often occurs in swimming, 
and seems here to be owing partly to the impression of cold on 
the surface, and partly to the restraint imposed on the muscles 
by being employed in an unaccustomed serie« of movements : 

64 



50G CRAMP — BLEEDING FROM THE NOSE. 

for, the more familiar the exercise, the less likely is this effect 
to follow. 

The relief of cramp, which is for the most part obtained 
without medical aid, consists in opposing the constrictive action 
o( one set of muscles by a voluntary exertion of the opposite. 
If, for example, the legs be spasmodically contracted, the will 
must be exerted to extend them. Often, however, it is found 
necessary to bring some extraneous force to bear on the part 
for the same purpose; and hence we find persons affected with 
cramp of the leg drawing the limb with the hand in the oppo- 
site direction. This plan is often aided by friction. 

Habitual cramp is generally a symptom of chronic irritation 
of the small intestines, resulting from some error of habit or 
diet, which being discovered and removed, the paroxysms of 
cramp disappear. 

Bleeding from the Nose occurs spontaneously under a great 
variety of circumstances, in many of which it may be regarded 
as unquestionably a salutary evacuation. We have already 
noticed its occurrence in catarrh, in which disease it often af- 
fords immediate relief to the inflamed mucous membrane. In 
other cases, the inflammations relieved by hemorrhage from the 
nose are located in distant parts ; as, for example in the throat, 
the lungs, or the membranes of the brain. 

This discharge is often of advantage when it supervenes upon 
local plethora or congestion, such as is produced in the vessels 
of the brain by close mental application. It is a common occur- 
rence, and often equally advantageous, in children who are un- 
dergoing the natural changes which take place as they ap- 
proach the age of puberty. Where habitual excesses at the 
table, and inactive habits, bring on a confirmed and general 
plethora, requiring periodical evacuations, the nose often acts 
as the flood-gate of the system ; and on the sudden suppression 
of established discharges or local irritations, which, though mor- 
bid in their nature, have become necessary to the health, by 
custom, the blood vessels of the nose occasionally open their 
sluices to the relief of the vital organs too frequently at- 
tacked in such cases. In violent paroxysms of passion or emo- 
tion, and in powerful muscular exertions, the ru^h of blood to 
the head would much more frequently occasion apoplexy, were 
it not that the sudden flow of blood from the nose often comes 
on and checks the attack. 

In these cases, hemorrhage from the nose cannot be regard- 
ed in the light of a disease, but the amount lost in certain in- 
stances becomes in itself a source of immediate danger, and 
in others the vessels of the mucous membrane become debili- 
tated by habit or disease, in such a manner as to lose in part 



BLEEDING FROM THE NOSE. 507 

their power of retraction ; and thus what are termed passive 
hemorrhages are produced, which are always more difficult of 
restraint either by natural or artificial means. In certain fa- 
milies, a tendency to this form of hemorrhage is hereditary, and 
frequently the same disposition is noticed in individuals as an 
idiosyncrasy. These last are by far the most troublesome forms 
of the complaint. It is certain, however, that when bleeding 
from the nose has become purely passive, it will proceed, if un- 
checked by art till it produces the most alarming symptoms. 
The quantity lost under these circumstances is sometimes enor- 
mous. Ten, twelve, and even twenty pounds, have been 
known to flow before the bleeding stopped. One case is re^ 
corded of forty-eight pounds ; one of eighteen pounds, within 
twenty-four hours; and one of seventy-five pounds within ten 
days, being double the quantity generally supposed to be con- 
tained in the whole body. It is evident that in the last case im- 
mense supplies must have been furnished by absorption to com- 
pensate the drain thus made upon the system. 

Independently, however, of those protracted hemorrhages 
which demand prompt and effective relief, there are conside- 
rations of convenience and comfort which make it desirable 
to check all bleedings, as soon as the relief demanded by the 
system is obtained. Nothing so readily becomes a habit, 
when indulged; and there is no habit with which, when con- 
firmed, it is more dangerous to interfere. It must be checked, 
therefore, if at all, at the onset; and, except under very pecu- 
liar circumstances, such as the presence of inflammatory dis- 
ease, apprehension of apoplexy, or the recent suppression of 
some very important discharge, the attempt may be made with 
safety, even from the commencement of the flow. When the 
evacuation is absolutely needed, mild measures will rarely 
prevent it from proceeding; while more severe remedies will, 
of course, be deferred, until the symptoms become alarming. 

The complaint rarely comes on, absolutely, without provo- 
cation. The slightest local irritation will produce it; but 
some irritation is necessary. Sneezing, the act of picking 
the nose, friction of the face after washing, stooping, &c* 
will often be sufficient to induce it in those predisposed. The 
entire avoidance of all these causes is, of course, impossible; 
but if they have been observed to act only periodically, as at 
a certain hour of the day, &c, a little caution will often pre- 
vent the anticipated attack; and thus, at least, break in upon 
the habit. 

The bleeding itself may frequently be arrested by the most 
simple means. The application of cold to almost any part of 
the surface will produce contraction of the extreme vessels 
generally, in which those of the mucous membrane affected 



508 STRANGURY. 

will participate. The simple expedient of placing a cold body, 
as a piece of iron in winter, or ice in summer, on the neck or 
back, will often be sufficient. A decided chill may be in- 
duced by the application of ice to the forehead and temples; 
and with more certainty, but less safety, by immersing the 
feet in extremely cold water. An agent of still more power, 
when it can be brought into action, is pressure upon the bleed- 
ing vessels by means of tents of sponge, lint, or muslin, 
which may be pushed into the nostrils from before, — or, if ne- 
cessary, and surgical assistance be present, — from behind also. 

Injections of astringent substances into the nostrils, have 
often arrested hemorrhage; and, of these, the best is the 
saturated solution of alum. When the plugs of lint, above 
mentioned, are steeped in this solution, their usefulness is ge- 
nerally increased. Creosote has been recommended for the 
same purpose; but our experience with this boasted remedy 
has not tended to raise our opinion of its powers in controlling 
hemorrhage. The dry powders of vegetable substances, have 
proved very efficacious, when taken in the form of snuff. 
They act by promoting coagulation; but the powdered leaves 
of the St. John's wort, {Uypericum perforatum,) has succeed- 
ed so admirably, in three cases of obstinate passive bleeding 
from the nose, that we cannot but recommend it to farther 
notice, as probably possessing other more efficient virtues. 

In some cases of obstinate and long continued bleeding from 
the nose, after every other remedy, internal and external, has 
been tried to no purpose, and great exhaustion has followed, 
it is found advantageous to resort to the use of direct stimu- 
lants. In a case of this kind, related by a distinguished me- 
dical author, the bleeding had continued for four days; during 
which time, the patient, a feeble woman, had been allowed no 
other nourishment than toast water. She was pale, sick, and 
without pulse. Port wine, with astringent injections into 
the nostrils, were prescribed, and, in a short time, the bleed- 
ing began to abate. 

The change from a meager to a better diet has had a happy 
effect in somewhat similar hemorrhages, from other parts; and 
in the hereditary variety, opiates appear to have succeeded in 
one case. 

Strangury consists in a painful emission of urine, which 
comes away only by drops, and generally with a sense of 
burning or scalding. The most common of its remote causes 
is the application of cantharides, in blisters, or internally ad- 
ministered. The immediate difficulty in this case, is proba- 
bly an inflammation of the neck of the bladder from the ab- 
sorption of the flies. Strangury is sometimes brought on by 
eolds. The indications of treatment are, to diminish the local 



DIABETES — GRAVEL. 509 

irritation, and to dilute the urine. The first object may be 
attained by the warm bath, fomentations to the abdomen, and 
warm injections; the latter being, sometimes, rendered more 
effectual by the addition of laudanum. At the same time, the 
mucilage of flaxseed or gum Arabic should be taken internally, 
in unlimited amount. 

A total stoppage of the urine may arise from the aggrava- 
tion of those causes which produce strangury, and, in this 
case, is removable by like means. But there are other causes 
also peculiar to this affection. A spasm of the sphincter mus- 
cle of the bladder may ensue on long continued voluntary re- 
tention, as when the mind is ardently engaged, and the calls 
of nature are neglected. This stoppage is generally relieved 
by the warm bath. There are other causes of strangury or 
retention of urine, but they are surgical in character, and need 
not be mentioned here. 

Diabetes. — The peculiar symptoms of diabetes mellitus, or sac- 
charine urine, is a profuse discharge of the urinary secretion, 
of a peculiar odour, resembling that of violets, and a sweet 
taste. The latter has been distinctly traced to the presence 
of sugar, resembling in all important particulars that of the 
cane. The attendant symptoms are thirst and debility; the 
accompanying circumstances are a voracious appetite, a dry, 
harsh skin, a clammy tongue, and general emaciation. 

It would be impossible, within our limits, to do justice 
to the description and treatment of this singular affection, 
which is too frequently fatal in spite of all the exertion of the 
practitioner; but the possibility of its occurrence, and the 
leading circumstances that characterize it, should be known to 
every one; since, if not checked at its outset, it is rarely con- 
trollable at a later stage. Whenever, therefore, the above 
combination of symptoms presents itself, it should attract im- 
mediate attention, and no time should be lost in seeking the 
best advice. 

Gravel. — The urine in its healthy state always contains 
more or less alkaline matter, held in solution by its peculiar 
acid, the uric or lithic. This alkali, which is for the most 
part of a calcareous character, is immediately secreted by the 
kidney itself. If either of these principles be in excess in 
proportion to the other, a deposite will take place, either acid 
or alkaline. In the former case, it sometimes concretes in 
the kidney, where it forms masses of considerable size, and 
sometimes is carried on to the bladder, where it shows itself 
in the form of red sand. In the latter case, the alkali, then 
set free, immediately unites with the phosphoric or oxalic 
acid, most commonly the former, which is always present, and 
forms a phosphate 6r oxalate of lime. For some reason, how- 



,510 GRAVEL. 

ever, yet unexplained, the phosphates rarely, if ever, concrete 
in the kidneys, but pass on to the bladder, where they consti- 
tute the alkaline or white sand. The presence of these de- 
posites is easily recognised by the appearance of the excretion. 
Late researches go to show, that the precipitation of lithic 
acid depends upon the presence in the urine of a free acid, 
commonly the muriatic, sometimes the phosphoric or sul- 
phuric, which acts by decomposing the lithates, and setting 
their acids free. 

A third form of calculous disease, and by far the most pain- 
ful and formidable, is that of a solid concretion in the bladder 
itself, constituting what is usually termed stone. These con- 
cretions are formed in the bladder by gradual deposite from 
the urine itself, around a central nucleus, which may be either 
a calculus which has made its way from the kidney, or some 
foreign substance introduced accidentally into the cavity- 
The most painful circumstance connected with this disease is 
the passage of the calculous concretion, when already large, 
from the kidney into the bladder. During this process there is 
fixed pain in the region of the affected kidney, with a numb- 
ness of the thigh on the same side, the pain alternating with a 
sense of weight in the part. The pain is acute, and accompa- 
nied with nausea and faintness, from the time when the calcu- 
lus has entered the ureter, until it enters the bladder; after 
which, there is a remission. If the stone should fortunately 
become engaged in the urethra, after reposing for a time in the 
bladder, its farther passage is attended with some pain; but the 
nausea that accompanies its previous course is wanting ; and 
the pain, instead of being deep-seated, is referred to the open- 
ing of the canal, and the actual seat of the concretion. While 
the stone is passing from the kidney to the bladder, the urine 
is usually high-coloured, and deposites a reddish sediment, not 
unlike coffee-grounds, the effect, probably, of altered blood 
flowing from lacerations of the mucous membrane of the ureter. 
The presence of stone in the bladder can only be certainly 
determined by actual examination by a surgeon; but if, after 
the passage of one or more calculi from the kidney, there is 
experienced a permanent difficulty in the evacuation of urine, 
with a frequent desire to discharge it, and this accompanied 
with acute pain at the termination of the urethra, the presence 
of stone in the bladder may well be suspected. When no 
passage of calculus or discharges of sand have been noticed, the 
existence of the disease is less readily recognised, but that some 
cause of irritation is present, will be perfectly evident ; since, 
in addition to the pain, it will soon be observed that the stream 
of water once commenced, is suddenly interrupted before its 
completion. As the stone enlarges, there will be a dull pain 



DROWNING. 51) 

about the neck of the bladder; while the irritation, extending 
itself to the rectum, will produce a straining and frequent de- 
sire to evacuate the bowels. These last symptoms do not ab- 
solutely determine the actual presence of calculus, but point 
out the propriety of a strict examination. 

Drowning. — In complete suffocation from drowning, all the 
mental and bodily powers, the sensibility, the action of all the 
muscles, voluntary and involuntary, are suspended ; the surface 
is cold, the heart ceases to beat, and no effort can detect the 
slightest action of the lungs. ■ 

The primary cause of death in drowning is believed to be as 
follows. The non-admission of air to the lungs, prevents the 
necessary changes in the blood circulating in their vessels. 
Hence this fluid passes, in the venous state, to the left -side of 
the heart, from which it is sent to the brain in such quantity 
as to destroy, or materially to impair, the vital powers. 

The following are the directions given by the humane 
society for the recovery of the drowned. The clothes should 
be immediately taken off, and the body wiped, cleaned, and 
wrapped in dry cloths or blankets, so as to prevent evapora- 
tion, and the effects of exposure to a cold medium. The body 
should then be carried in a recumbent posture on the back, 
with the head and breast raised. As soon as it has arrived in 
the room for its reception, it should be stripped and covered 
with warm blankets. If the mouth and nostrils be obstructed, 
they must be thoroughly cleansed. The lungs are then to be 
inflated, and dry warm flannels, bags of warm grain, or bot- 
tles or bladders of warm water applied to the region of the 
stomach, the soles of the feet, and other parts of the body. 
Bleeding ought never to be employed in this stage of the process; 
though it may become necessary, when reaction has taken 
place, and the circulation has returned. 

The longest period after submersion at which success from 
these means can reasonably be anticipated, is about fifteen to 
twenty minutes; but they should be tried after almost any 
interval, provided no structural injury has been inflicted, and 
there is no evidence of commencing putrefaction. The ac- 
counts which we have of recovery after eighteen, twenty-four, 
and even forty -eight hours of immersion, extravagant as they 
may be in themselves, are calculated to teach the useful lesson 
of perseverance, even in cases apparently desperate. The 
first report of the establishment for the recovery of the 
drowned at Paris, — one of the most trustworthy documents 
we possess on this subject,— gives twenty-three instances of in- 
dividuals brought to life. One had been under water forty- 
five minutes; four, half an hour; and three, for fifteen minutes. 



512 DEATH FROM SUSPENSION. 

In all the other successful cases, the period of immersion was 
less than this last. 

Death from Suspension may occur in either of three 
modes: first, hy a fracture or dislocation of the vertebrae, where- 
by the spinal marrow is compressed, and death occurs instant- 
ly. This is said to have been always effected in the hands of 
an expert executioner at Lyons, in France, who gave to the 
body of the criminal a peculiar rotatory motion in falling; but 
similar occurrences are very uncommon. Secondly, by pres- 
sure upon the superficial veins of the neck, so that the blood 
is arrested in its return from the brain toward the heart. 
This is an auxiliary cause, no doubt, in the great majority of 
instances; but. death may occur from this cause alone, when 
the cord is not tied with sufficient tightness to prevent respi- 
ration. In this case, the appearance of the face, and the gene- 
ral symptoms, are those of apoplexy. It is very unusual for 
individuals to recover under these circumstances, unless taken 
down very soon after insensibility takes place: We are told, 
however, of one or two instances, in which the victim of jus- 
tice has escaped death, in consequence of an ossification of 
the trachea. There is also a case recorded, in which a crimi- 
nal, before his execution, induced a surgeon to pass a cannula 
into the throat, by which, of course, the passage was rendered 
incompressible. After remaining suspended the usual time, 
he was cut down, and conveyed to the house of one of his 
friends; the jugular vein was immediately opened, and some 
blood obtained; he gave some sign, of returning animation, 
but soon expired. Recovery is still more difficult, when, as 
occurs in most cases, some obstruction of the air passage is 
superadded. Thirdly, the usual mode in which death occurs 
from suspension is, as in drowning, from suffocation; but, from 
the circumstance already mentioned, and the local injury 
usually done to the parts by pressure, reanimation, after hang- 
ing, is much more rare than when asphyxia has followed on 
submersion. As the occasion is seldom accidental, but usual- 
ly designed, in execution of the laws, or premeditated self- 
destruction, the opportunity of applying the appropriate means 
of relief is seldom offered for some hours. The treatment, in 
cases of death by suspension, should be, in most respect- 
milar to that already advised for cases of suspended animation; 
but, in the former, venesection affords, perhaps, a somewhat 
better chance of success, than in the latter class of accidents. 



L 



CHAPTER III. 
DISEASES OF MARRIED WOMEN. 



n the chapter on Hygiene we offered some remarks on the 
Subject of marriage. Supposing this ceremony to have been 
accomplished, it is now proper to impart some instruction to 
those who are anxious to be the parents of vigorous offspring. 
To promote this object, both parents should be in good gene- 
ral health; but the lady will claim our more especial attention 
in this chapter, as she is to be intrusted with a most sacred 
charge — the germ of a new being, whose destiny she cannot 
foresee, but whose position and usefulness in life will not be 
lightly influenced by her prudence or indiscretion. 

As it is our earnest desire to confine ourselves to the com- 
munication of information calculated to prove of real and 
practical value, and fitted for the class of readers to whom 
our remarks are addressed, we shall avoid, as impertinent to 
our object, those matters which are merely speculative, or 
adapted solely to the professional student. 

On Pregnancy, and the Position and Connexions of 
the Child in the Womb. After the foetus has been lodged 
for some time in the womb, and the several parts of its body 
and appendages have had time to become partially developed, 
it is found floating in a large sac, composed of three thin 
membranes placed one upon another, which line the whole 1 
interior of the womb, and enclose a large amount of a pe- 
culiar serous fluid, in which the foetus swims. 

At one spot on the outer surface of the external membrane, 
we find a large, thick, spongy, circular body, composed of in- 
numerable ramifications of blood vessels, which is really a 
vascular development of the membrane itself, and lies in im- 
mediate contact, but is not amalgamated with the inner sur- 

65 



514 PREGNANCY THE PLACENTA. 

face of the womb. This is the placenta, or after-birth. 
From the navel of the infant, to near the centre of the after- 
birth, we find a long tendinous cord, which is twisted, like a 
rope, and encloses within its substance, three great blood ves- 
sels; two of them termed the umbilical arteries, and the 
third, the umbilical vein. 

The child in the womb cannot breathe the air; and its lungs, 
even when fully developed, cannot contribute to the function 
of respiration; yet its blood requires the same change as that 
of animals after birth. (See Circulation.) This is effected in 
the following manner. The blood in the foetus, as it courses 
through the route of circulation, is made to pass through the 
umbilical arteries, which convey it to the afterbirth, where it is 
distributed through the exceedingly thin terminal branches of 
these vessels, and comes almost into contact with the blood of 
the mother in the minute arteries of the womb. It there ex- 
tracts from the latter the materials necessary to fit it for nou- 
rishing the body, and parts with such as unfit it for that pro- 
cess; in other words, the foetus breathes the blood of the mo- 
ther! and the after-birth is a kind of external, temporary lung, 
by means of which the child respires, much as certain reptiles 
do, which dwell perpetually in the water. 

The attachment of the placenta to the womb, has been com- 
pared to that of the little piece of wet leather which children 
call a sucker, and apply closely to bricks or other solid bodies, 
to lift them by atmospheric pressure. The umbilical cord cor- 
responds to the string which is fastened to the centre of the 
leather, by which, when traction is made in a direction nearly 
perpendicular to the surface of the leather, great force may be 
applied before the adhesion will be separated : but should 
separation occur between a considerable part of the surface of 
the placenta, and the corresponding part of the womb, the at- 
tachment becomes enfeebled, and little force is then requisite to 
complete the separation. We see, therefore, that while the 
development or growth of the placenta advances in proportion 
to the expansion or development of the womb, the adhesion 
remains strong, and the necessary and important changes in 
the circulating fluids of the child take place in this organ. 
But if any disturbing influence operate upon the muscular 
tissue of the uterus, to excite it prematurely to contraction, its 
connexion with the placenta is liable to be disturbed ; and, if 
any portion of the surface of the latter be detached, we shall 
not only have hemorrhage from the maternal vessels opposite 
to this detached portion, but the foetus must suffer for want of 
that nutriment, which is as essential to its growth and health 
as atmospheric air is to the respiratory animal. In this man- 



PREGNANCY — UNPLEASANT SYMPTOMS. 515 

her, if the foetus do not wither, its structure will be rendered 
imperfect; and if premature birth do not follow, it may be born 
at full time, but in a state of disease or deformity. From 
similar causes, it sometimes falls an early victim to chronic 
disorder; such as consumption, diseased spine, or hip joint, and 
scrofula. Even if the unfortunate infant should reach adult 
age under all these disadvantages, it may entail upon its off- 
spring the diseases acquired in its embryotic state. The mo- 
ther does not always escape the consequences of this separa- 
tion of the placenta : she may be very much exhausted by the 
discharge of blood at the time, whether abortion take place or 
not; and the unnatural drain from her system sometimes sub- 
jects her to protracted diseases of various kinds; and it has 
been observed, that women who thus suffered once, are sub- 
ject to repetitions of the same accident, in subsequent preg- 
nancies. Although it is difficult to establish such general rules* 
we might, perhaps, assert that a female is more exhausted by 
the effects of an abortion, than she would be by three succes- 
sive labours at full time, and at seasonable intervals. 

We have made these remarks, with the view to explain the 
slight mode of attachment between the ovum and uterus ; and 
when we consider the amount of blood which must circulate 
through the latter, to supply the wants of the foetus, we must 
regard the safe keeping of the ovum as a matter of very great 
importance to the mother. Both her moral and physical con- 
dition should be carefully regulated, and kept free from any ex- 
citement by over-exertion, excessive indulgence in eating or 
drinking, sudden changes in dress, &c. ; while every care 
should be taken to cultivate cheerfulness and tranquillity of 
mind. Her imagination should be as little excited as possible. 

The new action which the womb and its blood vessels 
assumes in consequence of conception, is very often the cause 
of disturbance to the functions of other organs; and hence the 
nausea and sickness of the stomach, especially in the morning, 
the capriciousness of the appetite, and the frequent desire to 
eat substances usually regarded as every way unsuitable for 
food; such as charcoal, dirt, putrid meat, &c. The nervous 
system becomes disordered ; hence the neuralgic pains, in the 
face or teeth. The temper is often petulant and morose, and 
in some cases the intellect becomes manifestly deranged. 

In many females, we observe, during pregnancy, a strong 
disposition to plethora or fulness of the blood vessels, and in- 
flammatory diseases ; but this is far from requiring, universally, 
the abstraction of blood; an opinion which has hitherto been so 
popular that almost every female seemed to consider preg- 
nancy and blood-letting, as necessarily associated. We do not 
hesitate to admit that, under these circumstances, some indi- 



516 PREGNANCY — CONSTIPATION. 

viduals require the use of the lancet, or some other raeana 
which will lessen the plethora; but we deprecate as injurious 
its indiscriminate employment in every pregnancy, and we be- 
lieve that a steady attention to diet, exercise, and the state of 
the bowels would generally render it unnecessary. 

Pregnancy is very often attended by constipation of the 
bowels; and some females, from ignorance or neglect, too fre- 
quently allow very large accumulations of hard fecal matter 
to fill up the rectum: these may sometimes become sources of 
irritation, capable of exciting premature uterine contractions, 
as well as a distressing bearing-down pain in the lower bow- 
els: they are also prone to cause the formation of piles, which 
often prove extremely troublesome. 

As we have already said, the digestive functions often share 
in the disturbance produced by pregnancy; hence flatulence, 
heart-burn, &c; which occasion such distress, that the patient 
will often seek relief by any means proposed, however ill-ad- 
vised. 

As pregnancy advances, many females are extremely fear- 
ful about the effect of the imagination upon the child; and if 
they meet with any untoward accident, or become suddenly 
frightened at any object, they conclude that an image of that 
object is immediately stamped upon the person of the foetus. 
If a strong desire be felt for fruit, fish, or any other article, 
the mother eagerly infers that, if unsatisfied, the infant will 
be born with the figure of the thing desired, impressed 
upon some part of its surface. On the other hand, if the 
child be born with any peculiar accidental mark, exube- 
rance, or deficiency, the memory is tortured to recall some 
cause for the appearance, of a similar character to those above 
noted. 

That strong impressions upon the feelings of the mother 
will produce a prejudicial' influence upon the health of the 
child, is indisputably true: and although the laws of nature 
are altogether opposed to the doctrine of mother-marks just 
mentioned, the prejudices of the ignorant upon this subject 
may be attended with some benefit to woman kind, 1 
curing more caution in the treatment of women during preg- 
nancy. 

If we except the errors of diet resulting from these notions, 
no great evil can be produced by them; and as it is utterly 
impossible to eradicate them from the minds of nurses, and 
many other kind and careful people, the medical philosopher, 
in addressing popular readers, must even be content to let them 
enjoy their reign. 

Constipation. For the all-important duty of regulating 
the discharge from the bowels, we should depend, as much a? 



PREGNANGY — HEART BURN. 517 

possible, on opening articles of food. If a daily effort at stool 
soon after breakfast fail to effect the purpose, the use of bran 
bread, and a little laxative fruit, such as apples, figs, or prunes, 
every day, will often succeed; and it is only when these means 
fail, that we should employ magnesia alone, or mixed with 
sirup of rhubarb, in a little lemonade. Pills of rhubarb and 
Castile soap, or castor oil, may be sometimes taken with pro- 
priety, to restore the daily evacuation; moderate dcses of ca- 
thartics, only, should be given in cases of pregnancy. 

The heart-burn is extremely apt to be induced or ag- 
gravated by constipated bowels and improper diet. Let those, 
therefore, who would escape so severe an affection, study the 
kind of food which is most easy of digestion, and does not 
produce acidity of stomach; an affection of very frequent oc- 
currence in pregnancy. 

The food of pregnant women should be simple, without 
much variety at the same meal, free from much spicing, and 
not consisting of too large a portion of animal substances. 
The breakfast should consist of stale, well made bread, with 
good butter, a little relish of dried beef, ham, &c, with a mo- 
derate amount of milk, coffee, tea, or chocolate. If the pa- 
tient be very far advanced, it is improper for her to stoop 
much; and if she be harassed with the " morning sickness," 
it is, perhaps, better that she should take her breakfast in bed, 
or rather that she should at least eat a little solid food before 
she rises. By a precautionary indulgence of this kind, we 
have known persons who had been previously much distressed 
with nausea in the morning, to be quite relieved. 

The dinner should consist of a moderate quantity of animal 
food, plainly prepared, with the addition of such vegetables as 
will not cause flatulence. Satiety should be carefully avoid- 
ed, as it is often followed by oppression, particularly in the 
advanced stage of pregnancy. The drink at dinner should be 
water, molasses and water, or milk and water. Wine, brandy, 
cider, porter, ale, and beer, should entirely be dispensed with, 
unless prescribed by a physician. 

The evening meal should always be light, composed of weak 
tea and coffee, plain bread and butter, with a relish of dried 
beef, ham, or fish. Hot bread or cakes, with melted butter, 
are highly objectionable in any stage of pregnancy. Few 
stomachs can digest them comfortably when in perfect health; 
and when this important organ is disturbed by pregnancy, 
great inconvenience is liable to result from indulgence in this 
kind of food. Late and hot suppers should be positively pro- 
hibited. 

Let the evening be passed tranquilly in the midst of the 



518 APPROACH OF LABOUR. 

domestic or social circle, free from any stirring emotions, 
especially avoiding the throng of the theatre and ball-room. 
Her own home, in the midst of substantial domestic comforts, 
is every way best adapted to a woman in this situation. There 
is often a sense of great languor and debility experienced by 
females, during some part of gestation; we would, however, 
advise them against too much indulgence in warm feather, or 
down beds, as by this means the system may become greatly 
relaxed and enervated: moderate exercise in open air, either 
in a carriage or on foot, is far better than a state of inactivity 
or indolent indulgence. The females of the labouring classes, 
who are able to command plain but wholesome food, but are 
obliged to use considerable exercise, usually enjoy better 
health, and transmit to their children more vigorous constitu- 
tions, than those of luxurious society^ 

The political economist is perfectly aware that, while the off- 
spring of the wealthy and hyper-refined become depreciated 
in physical and intellectual vigour, the children of those who, 
in the middle path of life, inherit the corporeal energies, and 
imitate the frugal habits of their parents, will rise to the high- 
est ranks of the community. Let then that female who ho- 
nourably aspires to transmit through a long line of posterity 
the impress of her own virtue, train herself for the important 
function of giving birth to, and educating healthy children. Let 
not wealth be apology for luxury, but let her lay aside every 
indulgence which would enervate her physical or depress her 
mental powers. 

Approach of Labour. Of this period the patient will pro- 
bably be apprized not only by her careful calculation that her 
" full time has expired," but by certain sensations of uneasiness 
about the lower part of the abdomen; a sinking down of the 
tumour which had been encroaching upon the region of the sto- 
mach; attacks of strangury or suppression of her urine; and, 
perhaps more frequently, a disability to retain it. She has at 
this time a strong sense of the necessity of evacuating the bowels: 
which are sometimes in a laxative, though more frequently in a 
very costive state. There is also generally a discharge of mu- 
cus, tinged with blood, from the vagina. The uneasiness and anx- 
iety now commonly become very great, and unless the patient 
possess much moral fortitude, she is apt, on the increase of these 
symptoms, to be affected with restlessness and fretfulness to such 
an extent as to super-induce febrile action, requiring restraint 
in a cool room, and the use of cold and laxative drinks. If 
there be headach with throbbing in the temples, the loss of a 
sufficient amount of blood to restore tranquillity may be re- 
quired. 



APPROACH OF LABOUR. 510 

By this kind of treatment, the pains and other symptoms are 
relieved for some time; and if the period of gestation be not 
completed, the relief will frequently continue till its termination; 
when there will be a recurrence of the same phenomena, and 
the patient should hold herself in readiness for an early 
labour. Her personal attire, and the furniture of her cham- 
ber, and bed, &c, should be arranged. For this purpose she 
should be provided with a loose wrapper, of a texture adapted 
to the temperature of her room, the under-dress should consist of 
a simple chemise, and a petticoat, which should be easy to slip 
off when necessary; she should have stockings without garters, 
and slippers on her feet : in this dress she may be allowed to 
move about as long as it is prudent for her to be out of bed; but 
when she is placed upon it for delivery, she should substitute a 
short night gown for the long wrapper. The chamber should be 
well ventilated, and properly warmed in cold weather. The win- 
dows should be so constructed that the air and light may be ad- 
mitted when needed, and excluded when unnecessary. If the 
labour take place at night, the lamp should be concealed be- 
hind some object, so that the persons in the room may be merely 
able to see their way about the room. Every thing should now 
be so conducted as to inspire the woman with courage and tran- 
quillity; and for this purpose the narration, in her presence, of 
unfavourable or tedious cases, of instrumental deliveries, &c, 
should be conscientiously avoided. Her bed should be placed 
with its foot and both sides at some distance from a wall, that 
the attendants may have a free passage about it, and the pa- 
tient may enjoy the fresh air. A mattress is decidedly prefer- 
able at any season of the year ; but if not at hand, such other bed 
as the patient possesses, should now be adjusted with the great- 
est regard to her present and future comfort. Let it be laid 
smoothly over the whole sacking bottom, and on its centre place 
a piece of oiled cloth, say a yard square, or more ; or, a blanket, 
or comfortable, as is most convenient, may be folded up and 
placed on the bed. Upon this cloth, lay the sheet or blanket on 
which the patient is to be placed after delivery. At the foot 
of the bed, and when practicable, at the right corner, let a si- 
milar arrangement of oil-cloth, or doubled bed-clothes be made. 
On this latter, the patient is to lay during the delivery. About 
the middle of the right side of the bed, a sufficient number of 
pillows should be placed for the comfortable support of the pa- 
tient's head. To the bed-post against which the feet are to 
be applied during the pains, a strong band or towel, a sheet, 
handkerchief, skein of yarn, or something of the kind is to be 
fastened, which the woman is to lay hold of when she make's 
an effort. Some loose light covering should be at hand, for her 



520 OF LABOUR. 

protection when in bed. While this preparation is being made, 
the patient may be allowed to place herself in any position she 
prefers; either to walk about the room, sit in her chair, or take 
her pains in a kneeling position, as is most agreeable to her. 
Strict inquiry should now be made into the state of the bowels and 
bladder; and if they have not been freely evacuated, by efforts 
which she has been forced to make, she should take a dose of me- 
dicine, when there appears to be time sufficient for the purpose. 
An ounce of castor oil will answer ; or, if the pains be urgent, 
we may give a large injection of a solution of Castile soap, or 
of molasses, with oil or lard and common salt, of each a table- 
spoonful, mixed with a pint and half of water. 

This measure will very frequently cause a full evacuation of 
the bladder; but if such a discharge do not occur, either from 
the action of the injection or in the natural way, the catheter 
must be introduced. This operation should be left in profes- 
sional hands, ;ind we shall not attempt to describe it. 

Of Labour. As it forms no part of our design in the pre- 
sent work to encourage the rash attempts of the ignorant to 
meddle in matters beyond their depth, we shall carefully con- 
fine our remarks to those subjects which may call for and ivar- 
rant the action of nurses and friendly attendants, whether in 
the ordinary progress of natural labour, when medical aid is at 
hand, or in emergencies, where it cannot be obtained. 

When the pains begin to be frequent, and pressing — it is time 
to send for the accoucheur, whose services, let us mention, 
ought in courtesy to be bespoke not less than three months be- 
fore the full period of pregnancy. But as the practitioner can- 
not always be obtained at a moment's notice, and there are 
other things besides Time a?i(/ Tide which wait for no man, 
the following directions may prove serviceable when women 
are confined, by necessity, in the absence of any experienced 
attendant. 

The bed having been arranged as already directed, (p. 519) 
the patient should be placed on her left side, with her dress 
rolled up, or folded under her hips, that it may be kept dry. 
The limbs should be drawn up towards the abdomen, the knees 
separated about five or six inches by a pillow or cushion, and 
the feet placed against the bed-post, while the head lies near 
the middle of the bed, supported by pillows at the height most 
agreeable to the patient. The hips should be brought within 
a foot of the lower edge of the bed; and the band, towel or skein 
of yarn already spoken of, should be placed within reach of 
the patient, that it may be laid hold of, whenever the pains in- 
duce her to seek such support. It should be impressed on the 
minds of all, however, that the straining exertions to assist na- 



OF LABOUR. 521 

ture which are often recommended by ignorant nurses, are ne- 
ver proper, and often highly injurious. The support afforded 
by the band or towel, should never be permitted to tempt the 
patient into powerful bearing down efforts. 

When the labour pains, at first sharp, cutting, and grinding, 
provoking a disposition to scream, become more supportable, 
and induce the woman to hold her breath, and make efforts 
to bear down, uttering, perhaps, occasional groans, we know 
that labour is advancing; and it is time to place the patient in 
bed, though the attitude above described, need not be assumed 
so early. Not long after the pains undergo this change, the 
membranes of the sac which contains the foetus are ruptured, 
and the contained fluid escapes, often much to the alarm of the 
patient. Sometimes the membranes may give way long be* 
fore this time; or they may be so firm as not to yield until they 
have distended the vagina, unless they be ruptured by artificial 
aid: this assistance may be safely given, whenever the bag of 
waters appears at the external orifice. By this time the head 
has generally passed so far through the pelvis, as to rest upon 
the perineum, which condition marks the beginning of the third 
stage: in this, the pains usually become more severe, as the ex* 
ternal parts are subjected to greater distention. 

When the head is about to escape from the vulva, the suf- 
fering of the patient is generally very acute, even when the 
labour has been tedious, especially if the parts have been 
fretted by frequent examinations, which too frequently excite 
an inflammatory disposition in these parts, and arrest the 
healthful secretion of the mucus which is designed to relax 
and lubricate the passage. 

It is at this time, therefore, that the most careful attention 
should be bestowed upon the perineum, which is exposed to 
danger. This part should be freely lubricated with lard, or 
some animal oil; after which the attendant should be prepared 
to support it, during the expulsion of the head, by applying to 
it the palm of the hand, covered by a soft towel, and making 
gentle pressure till the head has passed. 

The patient ought to be soothed and tranquillized as much 
as possible; for the intelligence that the head is born is often so 
pleasing, after a rending pain, that she will weep. Two or 
three lighter efforts of the uterus, without any aid from the mo- 
ther, now complete the third stage of the labour, and the 
delivery of the child. Let us here repeat our caution, that in- 
terference with the progress of this stage is injurious. Any 
effort on the part of the attendants, suddenly to withdraw the 
child from the body of the mother, may be very prejudicial ; 
for it is important that the uterus be allowed to contract gra- 
duallv, so as to expel the child by its own unaided efforts. The 

66 



522 OF LABOUR. 

only business of the attendant, at this moment, is to place a 
hand under the body of the child, and conduct it safely along 
the surface of the bed, keeping its mouth, in the mean time, 
entirely above the discharges which may be found on the 
bed. Its head should be covered, except the mouth, which 
should be freely exposed to the air until it breathes and cries, 
and until the pulse in the navel string has ceased, or has be- 
come very feeble. Then the navel string should be tied very 
tightly, with a thick, and pretty strong string, about three 
inches from the child's abdomen; it may then be cut about 
half an inch above the ligature. After ascertaining by careful 
inspection, that the ligature has entirely arrested the flow of 
the blood from the cut surface, the child should be laid in a 
flannel, or soft muslin cloth, and given to an assistant. The 
labour, which before engaged the whole attention of the mother, 
is now apparently, forgotten, all her complaints have ceased, 
and she lies quiet, unless active in giving directions about the 
dress of her babe, until after a few minutes, she feels another 
slight pain, which excites some alarm, unless its cause is ex- 
plained to her. This is an important moment with a well-in- 
structed attendant, who is aware of the hazard into which a 
patient may be thrown by mismanagement or neglect. The 
uterus, which has been firmly compressed about the whole 
ovum until the rupture of the membranes, has now become 
suddenly emptied of every thing but the placenta and mem- 
branes. From the surface of the womb, hemorrhage, to a 
greater or less extent, will follow, unless the contractions of the 
uterus have closed up the orifice of the vessels. To prevent 
mischief of this kind, a hand should be conveyed beneath the 
bed-clothes, and placed upon the abdomen of the patient; and 
frictions should be made over the region of the uterus, until the 
or^an is felt contracted into a hard tumour just above the 
pubes. No effort should be made forcibly to extract the placenta, 
unless the precautionary friction has effected a decided disposition 
in the uterus to contract upon it. The cord may then be em- 
braced in the fingers of the other hand, and a very gentle 
traction may be made; the cord beinej carried backward as 
far as possible toward the perineum, if the placenta be high 
up in the pelvis, and more forwards toward the thighs, if it be 
near the external parts. 

The patient usually feels some slight pains during the expul- 
sion of the after-birth. When the mass of it has passed the 
vulva, it should be carefully twisted two or three times upon 
itself, that the membranes may be more certainly brought 
away entire. As soon as this is done, it should be removed in 
a suitable vessel. A soft cloth should then be placed gently 
against the vulva, the pillow removed from between the knees.- 



LABOUR — MANAGEMENT OF THE CHILD. 523 

and the patient allowed to straighten herself out on the bed. 
A bandage, ten or twelve inches in widlh, and long enough to 
surround the waist, should be applied under the hips and back, 
then brought round to be fastened in front, just above the 
pubes, and along the middle line of the belly, to give uniform 
pressure to the whole abdomen. If there be any disposition to 
hemorrhage, it will be proper to apply a few folds of compress 
upon the pubic region, beneath the bandage, to prevent the 
womb from being distended with blood. 

When this has been done, the patient, if fatigued or debili- 
tated, should be allowed to remain for some time at rest, without 
being drawn up in bed; but if not so to any considerable 
degree, she should be gently slipped up to her proper position, 
all the wet clothes removed from about her, and the articles 
of dress which have been folded up above her hips, spread 
about her lower extremities. It is not unusual for women at 
this time to have a shivering, and apparent chill ; when this 
occurs, they should be well covered up, and allowed some mo- 
derately warm gruel or panada, free from any stimulating 
liquors, the room should be made quiet, and they should be 
allowed a little repose. 

Management of the Child. — Mean while the child will re- 
quire attention. A basin of tepid water with fine soap, and a 
cup of lard should be at hand, for the necessary ablution. It 
is usual for children to be born with a considerable quantity of 
sebaceous matter upon the skin, which the nurses find difficult 
to remove by the ordinary modes of washing; but if the body 
of the child be well anointed with lard, it is very easily taken 
away by a subsequent washing with soap-suds. The towel 
which is used in washing or wiping, should be soft and plea- 
sant. We have seen some careless nurses use coarse crash 
towels, with which they would almost peal off the cuticle, re- 
gardless of the cries of the child. The navel is to be dressed by 
taking a little fine linen rag, and having doubled it two or 
three times, a perforation is to be made in its centre, through 
which the cord is to be passed ; the linen is then to be folded 
neatly around it, and placed on the middle line of the abdo- 
men, towards the child's chin ; over this is applied a broad flan- 
nel bandage, extending from the hips to the armpits, over-lap- 
ping a little in front, that it may be readily secured by tape or 
braid strings. This bandage should be moderately tight. We have 
seen children so girdled that they could scarcely breathe, and 
would have died, if the bandage had not been very soon slack- 
ened ! The rest of the dress should be loose and easy, but may 
in other respects be made to suit the taste of the mother. 

It has long been the custom of nurses literally to cram the 
infant with panada, gruel, or tiff; and even at the present day 



524 LABOUR SUSPENDED ANIMATION AT BIRTH. 

it is said, a little molasses and water are necessary, " to purge 
offthe economy." But nature, mostly provident of her offspring, 
supplies the only true source of nutriment and physic in the 
mother's breasts. To these, therefore, let the child be applied, 
as soon as it is dressed, and the mother a little refreshed. The 
advantages to be derived from this course are such as to com- 
pensate the mother and nurse for their early pains. The child, 
by this means, clears the mucus from its mouth in the effort 
at suction. If it draw any fluid from the breasts, this com- 
monly purges it sufficiently. By the suction, the breasts are 
also excited into action, the nipple becomes erect, and milk 
flows readily, much sooner than if they were kept in a quies- 
cent state for several days. VV 7 e believe we may safely state 
that, after attentive observation for several years, we have 
never known a case of milk fever or milk abscess, in a person 
who has used the precaution of an early and persevering ap- 
plication of the child to her breasts. 

After difficult labours, when the head of the child has been 
long locked between the bones of the pelvis, it will frequently 
be moulded into a conical shape, with the bones in some 
measure over-lapping each other. This appearance usually 
alarms inexperienced mothers and nurses, who think it neces- 
sary to set about correcting the defect. Nothing, however, 
should be done in such cases; for, if let alone, the parts will be 
restored to their proper form in the course of a few days. If, 
however, the scalp is very much bruised or swollen, a cloth 
wet with vinegar or diluted spirits, may be laid over it. 

Some children are born apparently dead, when, by a little 
care, they may be resuscitated: for this purpose, they should 
not be separated from the placenta, by dividing the cord, 
while there is any pulsation in it, and the children are feeble 
and pale; but if they be purple or livid, the cord should be 
cut, and an ounce or two of blood abstracted from the foetal 
part of it; care being taken to apply a ligature securely 
around it, as soon as it has bled enough to relieve the child 
from this apoplectic state. This treatment, however, is hardly 
safe except in professional hands. The child should next be 
taken from the bed, and laid in the lap of an assistant near 
the tire, wrapped in warm flannel, and its whole body very 
gently but briskly rubbed with a piece of the same cloth, wet 
with warm spirits: the soles, palms and back, should be rubbed 
with a soft brush; the throat of the child should be carefully 
examined, and if it contain mucus, this should be cleared 
away by a soft rag, wrapped upon the end of the little-finger. 
A little ammonia, or some other pungent volatile substance, 
may then be held near its nose or mouth, or a small quantity 
may be rubbed on the tongue. If this do not succeed in soon pro- 



LABOUR AFTER-TREATMENT. 525 

voking an effort to sob, artificial respiration must be attempted. 
For this purpose, the nostrils should be closed, and air breathed 
by the attendant into the mouth of the child, and thus into its 
lungs; this is to be gently pressed out again by the hand of the 
operator, and the operation repeated several times, at intervals 
of a few seconds. In a case of asphyxia, which came under 
our care, the heart continued to throb for nearly thirty minutes, 
while we employed artificial respiration, though it ceased as 
soon as we remitted our exertions in the least degree. In ad- 
dition to the above means, warm injections thrown into the 
bowels have been very useful. 

Instances are recorded in which respiration has been esta- 
blished even after the interval of two hours from the birth of 
the child. A faint sighing, or a full pulsation of the heart, are 
the first signs of returning life. They should be encouraged by 
gentle perseverance, but always without any harsh measures. 

The After-treatment of the Lying-in Female should be mild. 
By careful attention to the diet, bowels, bladder, and breasts, 
she will usually escape any indisposition. As a general rule, 
she should have her bowels opened by a dose of castor oil or 
magnesia, about the second or third day. After this, if the 
diet be of the proper kind, the bowels act for themselves ; but 
if I hey do not, either oil or magnesia, or, if there be a little dispo- 
sition to fever, a Seidlitz powder may be given every other 
day. The patient should be kept quietly in bed for the first 
three or four days; after which, she should be allowed, under 
favourable circumstances, to sit up in bed, or even to leave it 
for a few minutes that it may be made up. The parts which 
have been recently too much distended should be washed with 
tepid water, which will be not only very refreshing, but prevent 
the accumulation of any of the lochial discharge, that con- 
tinues for some time after delivery. After-pains, which seem 
to arise from continued contractions of the uterus after the 
expulsion of the ovum, rarely succeed a first labour: but in 
subsequent labours, they sometimes become very annoying. 
They may be mitigated by twenty or thirty drops of lauda- 
num, or one-eighth of a grain of the sulphate of morphia, every 
two or three hours: or sixty drops of the former may be given 
in an ounce or two of starch water, as an injection. After the 
fourth or fifth day, the patient may be permitted to assume more 
frequently the sitting posture, and to indulge in food of a more 
nutritious kind, but she is constantly to remember that partu- 
rient women are very liable to attacks of inflammatory dis- 
eases, especially after the use of stimulating food or drinks. 

Of Rupture of the Uterus. Either from deformity of the 
pelvis, from some imperfect or irregular action of the muscu- 
lar fibresof the womb, or from some diseased condition of its 



526 rupture or THE uterus. 

structure, it is liable, during labour, to be lacerated in some 
portion of its substance, so as to permit the escape of the child 
into the cavity of the abdomen. The accident may happen 
at various periods of labour, and has even been known to oc- 
cur during the last pain which delivers the child. This un- 
happy circumstance is indicated by a sense of something 
giving way internally, preceded by a very severe pain, gene- 
rally mistaken for a cramp, and immediately followed by a 
sensation of great languor and debility; a speedy and, some- 
times, instantaneous vomiting of the food previously taken, 
or of a brownish, coffee-coloured fluid; a very quick, weak, 
fluttering pulse; cold sweat; difficult respiration ; and an in- 
stantaneous cessation of the labour pains. Through this lace- 
ration, either a part, or the whole of a foetus may pass. There 
have been instances in which the head has been retained in the 
cavity of the pelvis, whilst the body and the lower extremities 
were found in the cavity of the abdomen. The peritoneum 
is not invariably lacerated, even when such protrusion takes 
place — nor does this species of accident always cause the 
death of the patient. Cases of this kind are, of course, beyond 
the aid of any but the most able practitioners, and cannot be 
treated by popular skill. 

Uterine Hemorrhage. Let us suppose the delivery of the 
child happily completed, and both the patients and her friends 
expressing their satisfaction. In the midst of these seemingly 
happy circumstances, the former may cry out, "Doctor! I am 
sinking! I've a great discharge!" On examination, the practi- 
tioner is startled to find his patient drenched with blood, 
escaping in such quantity, as not only to flood the bed, but, 
perhaps, to form a puddle on the floor! In other cases, there 
may be no external discharge, but the cold skin, pale visage, 
eyes rolled up, and the exclamation " How the room turns 
round!" all speak the mischief which is going on within. 
The vessels of the surface of the uterus are bleeding with open 
mouthsy either in consequence of a partial separation of the 
placenta, or a want of tonic contractile powers in the fibres of 
the womb. 

In this condition, not a moment is to be lost. If no physi- 
cian be present, and the placenta be undelivered, an experienced 
nurse may venture to introduce into the passage the fore-fin- 
ger of her right hand, well coated with lard, — back, palm and 
all. — If the after-birth be found chiefly in the vagina, she may 
introduce the whole hand, and passing her fingers to the open 
neck of the womb, she may remove it, if this can be done with- 
out force, by pressing it down from above, while she draws 
gently on the cord with the other hand. But if she meet with 
resistance from the part of the placenta within the womb, or 



PUERPERAL CONVULSIONS. 527 

if no considerable portion of the former be found within the 
vagina, then the hand must be withdrawn. 

When the after-birth is retained partly or wholly within 
the womb, during uterine hemorrhage, it should be as little 
disturbed as possible, until the organ contracts sufficiently to 
expel the placenta entirely into the vagina. This contraction 
may be safely promoted by the following measures: First, by 
friction steadily made with the hand above the pubis, and fre- 
quently patting the same part in a gentle manner. This is 
the feeblest measure, but it will often succeed in mild cases, 
and is a valuable assistant to other means. Secondly, by the ex- 
hibition of twenty grains of ergot in a gill of water every half 
hour. This should not be continued beyond the fourth dose. 
It often acts very powerfully. Thirdl}', by cold affusion on 
the surface of the abdomen, by pouring upon it, from a consi- 
derable height, a stream of cold water. This is best accom- 
plished by employing a pitcher or tea-pot for the purpose. 
The impression should be sudden, so as to secure a decided 
shock. It is a powerful remedy. 

The art has other and more certain resources; but as they 
can only be safely directed by professional men, we shall not 
attempt to describe them here. Even after the placenta is 
delivered, there is no absolute safety, until the uterus can be 
felt, firmly contracted into a hard, round ball behind the 
pubes. In some instances, after copious hemorrhages, which 
have been, in great degree, arrested by the uterine contrac- 
tions, there remains a slight dribbling of blood, proving a 
source of exhaustion and subsequent ill health. This dis- 
charge often yields to the employment of cool astringent in- 
jections, which may be safely employed, when the general 
health of the patient has been good. Among the best of these 
are lead water, and the solution of alum. Muriated tincture of 
iron, greatly diluted, is employed as a powerful remedy by 
practitioners, but it is not a safe article in unprofessional hands. 
The after-treatment of the debility occasioned by the hemor- 
rhage, should be conducted on the same general principle. 
This diminished discharge sometimes yields to the internal 
use of two or three grains of sugar of lead, or the same quan- 
tity of ergot, administered every two or three hours, during 
one or two days. 

Of Puerperal Convulsions. There is another class of af- 
fections, of a most terrific nature, to which women are occa- 
sionally liable, generally about the parturient period; though, 
sometimes, before the time of confinement, and, in a few in- 
stances, shortly after delivery: we mean puerperal convul- 
sions. This terrible class of maladies is most commonly ma- 
nifested in first pregnancies. 



528 PUERPERAL CONVULSIONS. 

Affections of this character appear under several varieties. 
They are either apoplectic, hysteric, or epileptic, each of which 
forms is preceded by peculiar symptoms denoting its approach. 
The apoplectic species is generally ushered in by a strong deter- 
mination of blood to the head, with an engorgement of the ves- 
sels, more or less severe headach, ringing in the ears, loss of 
sight, giddiness, &c. These precursors often continue but a 
very short time before the convulsion is ushered in by coma 
and stertorous breathing. In some cases the patient has sud- 
denly cried out, "My head!" "my head!" has become con- 
vulsed, and died in a few hours. 

In the epileptic variety, these premonitory symptoms may 
be present several days before the convulsive movement be- 
comes very conspicuous. There is, during the paroxysm, a 
perfect suspension of all consciousness; for, when it has passed 
over, the patient is not aware of what has happened. She 
may look around the room, apparently in a state of surprise, 
then gradually sink into another convulsion of more or less 
intensity. 

The epileptic variety of puerperal convulsions is not pre- 
ceded by that peculiar creeping sensation along the limbs and 
back, which is so often felt before an attack of common epi- 
lepsy; but, in other respects, the former resembles the latter 
very closely. The face is swelled, and the countenance is 
contorted by twitches which contract the muscles suddenly 
and in all directions, while the eyes are rolled about with 
great rapidity, and the tongue protrudes and becomes black. 
The whole body is violently agitated, though sometimes one 
side is more affected than the other. Respiration is alternate- 
ly hurried and suspended, and the accumulation of saliva about 
the teeth causes a hissing sound in breathing. The pulse is 
at first full, frequent, and tense; but quickly becomes rapid, 
small, and almost imperceptible. During the paroxysm, the 
urine and feces often escape involuntarily; and the attack usu- 
ally declines with a cold, clammy sweat, covering the whole 
body of the patient. 

In the hysteric form of this disease, the headach, if present, 
is neither so severe nor permanent; there are ringing in the 
ears, hysterical ball, and palpitation of the heart. The face 
is not so much convulsed; the eyes do not vacillate so much, 
though there is more violent contraction of the large muscles 
of the body; the countenance is less flushed than in either 
the apoplectic or epileptic variety; there is rarely much 
frothing at the mouth, nor is there any hissing sound in 
breathing, and the pulse is less disturbed. This last species 
of the disease is more prone than any other to attack women 



PUERPERAL CONVULSIONS. 529 

of delicate nervous habits; who, however, generally recover 
from it more rapidly than those affected with either of the 
other varieties. 

There are several other forms spoken of by different au- 
thors; as the tetanic, cataleptic, &c, all of which appear to us 
to be but grades of the same terrible disorder, requiring mere- 
ly a slight modification in the treatment. There is, however, 
a species of convulsion, mentioned by a late practical writer, 
occurring under circumstances entirely different: we mean the 
anemic convulsion, in which powerful muscular efforts take 
place after the system has been almost drained of its blood 
by uterine or other hemorrhages. 

Puerperal convulsions arise from a variety of causes. It is 
well known that, during gestation, there is in most women a 
greater than ordinary disposition to plethora, as well as to 
nervous irritability. In most instances of this disease, there 
is a great determination of blood to the head, evinced even 
for some time anterior to the attack. The efforts of the pa- 
tient during labour, as well as the interruption to the free cir- 
culation of the blood through the lower extremities, in conse- 
quence of the pressure made upon the blood vessels by the 
enlarged womb, are obvious causes of the apoplectic variety; 
while a certain degree of plethora* complicated with nervous 
excitability, may induce the epileptic form of the disease. On 
the other hand, the hysterical form probably depends entirely 
upon the exalted sensibility of the nervous system; as do also 
the tetanic and cataleptic varieties. The treatment of this 
disease, therefore, must be modified by the- circumstances 
which contribute to its occurrence. 

In the apoplectic variety, the lancet should be freely used, 
and blood drawn copiously from the general system. Cold 
should be kept about the head, whilst powerful revulsives, 
such as strong mustard plasters, should be applied to the low- 
er extremities. If the patient can be made to swallow ten or 
fifteen grains of calomel, followed by an active dose of the 
infusion of senna, it should be promptly administered, and 
the operation quickened by free injections of senna tea, or 
other powerful purgatives. Opiates, or narcotics, in any form, 
are highly prejudicial in this species of the disease, unless af- 
ter much depletion, when the case becomes resolved into one 
of nervous excitement alone. The same course is to be pur- 
sued in the epileptic form, except that depletion need not be 
carried quite so far, and anodynes and antispasmodics may be 
administered rather earlier, and in conjunction with the other 
measures. * 

In the hysteric variety, vascular depletion is less necessary, 
and may be often dispensed with altogether. A brisk purgative 

67 



530 INVERSION OF THE UTERUS. 

combined with an anodyne or antispasmodic, such as Hoffman's 
anodyne, or asafcetida, with revulsive applications, are gene- 
rally sufficient to restore the regularity of the nervous action. 

Of the tetanic, cataleptic, and anemic varieties, we know 
very little; but should we meet with them, we should be dis- 
posed to treat them in nearly the same manner as other forms 
of the disease. 

In some cases it is proper to deliver the child immediately, 
by artificial means, when puerperal convulsions occur before 
the birth of the child; and there are not wanting instances in 
which the life of the child has been sacrificed to save that of 
the mother, under such circumstances. But the fearful respon- 
sibility assumed by those who dare to act as the arbiters of 
life and death, confine the practice within the highest walks of 
the profession. 

Inversion of the Uterus may be partial or complete: in the 
latter case, the whole organ becomes turned inside out, ex- 
posing its internal surface. The whole mass may either be 
thus presented at the external orifice of the vagina, or, if not 
very large and engorged, may be concealed within that canal. 

The symptoms attendant upon this event, are severe and 
distressing pain about the region of the uterus ; an effort to 
force or bear down, nausea and sometimes vomiting, great 
faintness, with more or less hemorrhage, cold clammy sweats, 
and a pulse small, frequent, or perhaps entirely absent. The pa- 
tient also suffers very much from nervous agitation of the sys- 
tem. 

The symptoms of partial invertion are similar to those of 
complete invertion; but there is almost always a greater amount 
of hemorrhage in the former case, probably in consequence of 
the constriction of the orifice of the womb upon the parts 
which have become engaged in it, which has been known ac- 
tually to arrest the circulation, and produce gangrene of the 
prolapsed portion of the organ. The pain suffered by the pa- 
tient, is in some degree proportional to the extent of the in- 
version. It is comparatively slight when no part of the body 
of the womb has passed through the neck, and in more consi- 
derable inversions it depends much upon the tightness with 
which the orifice of the womb contracts. 

It would be folly to enter upon the mode of treating this 
accident, in a popular work, except to mention that if a com- 
plete inversion of the womb should occur where no medical 
aid can possibly be obtained, it would be warrantable in an 
intelligent assistant to attempt the reduction by pressing up- 
ward the middle of the tumour with well greased fingers, and 
then proceeding in much the same manner as in prolapsus of 
the anus. After the reduction,, the hand, smoothly doubled up 



INFLAMMATION OF THE WOMB. 531 

should be fairly introduced into the cavity, and there retained 
till expelled by the contractions of the womb. It has been gene- 
rally supposed that a womb completely inverted, could not be 
reduced; but we fear that the attempt has not been made judi- 
ciously as often as it should have been. If a few hours of time 
are lost,. it will probably prove impossible; but we cannot per- 
ceive any insuperable barrier against success, when it is made 
with promptitude. Dr. C. D. Meigs has succeeded recently in 
one case in Philadelphia, and the ease with which the reduc- 
tion is effected in the larger domestic animals is no weak ar- 
gument in favour of its possibility in the human species. Com- 
plete inversion is not always fatal. There is one case in this 
city, in which it has existed for many years; and it is even re- 
commended that, when incomplete and irreducible, it should be 
completed, to secure additional safety from the fatal effects of 
stricture. 

Inflammation of the Womb may occur at almost any period; 
but is, of course, most frequent soon after delivery. It usually 
appears between the second and fifth days, inclusive. The 
pain in the uterus is constant and violent, but subject to con- 
siderable exacerbations. This pain is distinguished from after- 
pains by its constancy, and by extreme soreness on touch over 
the lower part of the abdomen; but the tenderness extends 
no farther, unless the peritoneum become implicated. 

Both the milk and the lochia, (discharges of bloody serum 
following confinement) are suppressed soon after the attack, 
and general fever soon makes its appearance. This fever is 
rarely ushered in by a chill; it is, however, attended by head- 
ach, and if not soon relieved, by delirium. The tongue is 
white, furred, and sometimes dry, or covered by a clammy 
fluid, causing great thirst. In the progress of the affection, the 
back and thighs participate in the pain. Pretty severe pain is 
also felt in many cases on the left side below the ribs. The 
urine is scanty, high-coloured, and deposites a sediment: some- 
times it is almost suppressed. The bowels, in the commence- 
ment of tiiis disease, are generally bound, though in the latter 
stages a diarrhoea comes on, proving critical in some cases. 
The disease sometimes runs into suppuration, but mortifi- 
cation is a rare occurrence. 

Active vascular depletion during the inflammatory stage is 
most useful : bleeding from the general system should be 
promptly effected ; after which, the application of leeches to the 
vulva, groins, and, if medical aid be in attendance, even to the 
neck of the uterus itself, will be highly advantageous. These 
measures may be followed up with much relief to the patient, 
by warm fomentations to the parts. The bowels should be 
kept moderately open by laxatives or even saline cathartics. 



532 PUERPERAL FEVER. 

After the febrile action has been reduced, if there remain much 
local unneasiness, a blister applied to the lower part of the ab- 
domen, sacrum or thighs, will generally afford great relief. 
The various secretions should be restored by appropriate means, 
and sleep induced by opiates, after the vascular excitement has 
been sufficiently reduced. If there be a throbbing sensation 
felt in the uterus, with an irritated state of the pulse, blood- 
letting, if performed at all, should be resorted to with great 
caution ; as suppuration being about to take place, the system 
will not bear vascular depletion. If an abscess should form, 
and the pus be discharged, the parts should be kept well 
cleansed by bland injections; such as warm gum-water, flax- 
seed tea, or infusion of slippery elm, thrown into the vagina 
by a proper syringe. Under all circumstances, the patient 
should be confined to the horizontal position for sometime after 
the disease has apparently subsided, as the uterus, while re- 
maining in a state of engorgement, will be much disposed to 
prolapsus or falling. 

Of Puerperal Fever. Women in child-bed are, occasion- 
ally, the subject of a more terrific and unmanageable form of 
disease than that just described, — a disease which sometimes 
becomes epidemic or endemic, sweeping; off great numbers 
of lying-in women, whether in the wards of an hospital, or 
scattered over large cities or sections of country. 

This affection does not appear to be attributable either to 
variety of constitution, or to the easy, severe, natural, or in- 
strumental character of the labours; but about the second day 
after delivery, the patient complains loudly of after-pains, and 
refers her suffering to the region of the pubes and uterus. She 
will have severe rigors, with a pulse varying from one hun- 
dred and twenty to one hundred and sixty. Both her bodily 
and mental energies are very much prostrated, there being an 
indescribable sense of distress about the chest, with a total sus- 
pension of maternal feelings. The skin sometimes becomes 
hot and dry, the face flushed, and the intellect evidently dis- 
turbed. Respiration is performed laboriously, and by sighs. 
The abdomen is so sore, that it will not bear the slightest 
pressure, and it is rapidly distended, till as large as it was be- 
fore delivery. The stomach soon shares in this disturbance; 
and in the midst of the tossing and restlessness of the patient, 
it throws up morbid secretions, at first, of a bilious character, 
but afterwards, of the colour of coffee-grounds. The face as- 
sumes a ghastly appearance; there is a livid circle about the 
eyes, singing in the ears, headach, a pale or red tongue, and 
parched lips. The breasts fall, and the lochia sometimes be- 
come suppressed. The bowels in the early stage are consti- 
pated, — the urine scanty and high-coloured. The eves be- 



PUERPERAL FEVER. 533 

come dull and the pupils dilated, the features appear sharpened, 
the cheeks suffused with a hectic flush, the skin presents a ca- 
daverous hue, the patient lies on her back with her lower limbs 
drawn up to relieve her respiration, which is greatly impeded 
by the tumefaction of the abdomen, and, as the affection has- 
tens towards its fatal termination, it assumes many of the cha- 
racters of the gravest fdrms of typhus fever. This whole 
round of changes from apparently safe delivery to death, has 
been known to be completed in thirty-six or forty-eight 
hours. 

In a disease of so fatal a character, and involving so serious 
a responsibility, as that now under consideration, we shall be 
justified in urging the following important directions, when 
medical aid cannot be procured. 

Let the patient, if possible, be kept in a large, well venti- 
lated, quiet apartment, secluded from any disturbing influence 
of visiters: let her be freely bled at the very onset of the dis- 
ease; let her bowels be thoroughly evacuated with calomel 
and jalap, say ten grains of each. Should not the first bleeding 
afford decided relief of the sufferings, direct the repetition 
of the operation, even though the blood at first drawn do not 
present a buffy coat. Whenever the pulse, by such repetition, 
becomes somewhat reduced in force, if the tenderness still 
continue, let the abdomen be covered over by a number of 
leeches, particularly about the affected part. After this, if 
the constitutional symptoms continue while the system is 
in a situation not to warrant farther vascular depletion, and if 
the stomach be irritable, administer the saline draught. If the 
pulse become small and somewhat feeble, give twenty or thir- 
ty drops of spirits of turpentine every hour, with the mercu- 
rial ointment, covering the abdomen at the same time. If there 
be a discharge of the lochia, it is almost always intolerably 
offensive: when this is the case, the vulva should be carefully 
cleansed with luke-warm water, and the clothes constantly 
moistened with pyroligneous acid or solutions of the chlorides 
of soda or of lime; or small quantities of these salts may be 
kept in saucers in various parts of the room, or under the bed- 
clothes. 

The diet should be extremely light in the inflammatory 
stage, and confined to the following articles; namely, toast 
water, gum water, thin barley or rice water, lemonade, rennet 
whey, molasses and water, and balm tea; carefully avoiding 
every preparation of animal substance, however delicately 
prepared, so long as the patient has the slightest. symptom 
of fever; for although chicken water may enter the dietetic 
list of European writers on this disease, it must be kept out 
of the catalogue of indulgences in the affection, as it generally 



534 PHLEGMASIA DOLENS. 

occurs in this country. To avoid fatigue from rising to re- 
ceive the nourishment, it should always be administered from 
a sick cup or tea-pot spout. The medicine should be given 
by a spoon, and the discharges from the bowels should be re- 
ceived in a bed-pan, or what is still better, in states of great 
debility, an ordinary tin dusting pan, the thin front edge 
of which can readily be slipped under the nates of the patient 
without disturbance. 

The bed and body clothes should be changed and well pu- 
rified very frequently, as far as can be done without exposing 
the patient to too much fatigue. The bed-clothes should be 
supported above the body by a suitable frame-work, the most 
simple of which is described at page 327. The abdomen may 
be kept wet with some spirits of hartshorn, camphor, or tur- 
pentine, if it be grateful to the patient. The secretion of the 
breasts should be promoted by the occasional application of 
the child, or some other suction power, whenever this can be 
done without too much fatigue and disturbance to the mo- 
ther. 

The gradual subsidence of this state of severe indisposition 
will be known by the diminution of the frequency of the pulse, 
and an increase of its volume and force, a gentle perspiration 
on the whole cutaneous surface, a moderate and frequent dis- 
charge from the bowels, a restoration of the urinary secretions, 
tranquillity of mind, &c. The diet may be gradually increased 
in strength, and moderate exercise should be encouraged. 

Swelled Leg, Milk Leg, or Phlegmasia Dolens. — This very 
troublesome, painful, and tedious, but not very dangerous affec- 
tion, may occur to the lying-in female at an earlier or later 
period. 

The patient, perhaps previously well, is attacked by chill, 
followed by fever, with pain in the hip, the groin, and perhaps 
the back, or the calf of the leg. In a few hours, the painful 
parts of the affected limb begin to swell rapidly. The swelling 
extends in all directions, until the member becomes hard, 
white, glossy, incapable of receiving an impression from the 
finger, exquisitely sensitive in every part, and moveable with 
great difficulty, or not at all. 

But one limb is affected at a time, but when the inflamma- 
tion begins to decline in this, it sometimes commences in the 
other. The swelling often affects the labium of the diseased 
side, but finds itself accurately bounded by the middle line of 
the body. 

Suppuration rarely takes place in this disease, but we have 
seen a case of repeated ulcerations in a limb affected with 
chronic phlegmasia dolens. 

This disease being inflammatory in its nature, requires de- 



PUERPERAL NERVOUSNESS, MANIA, AND MELANCHOLY. 535 

pletion for its relief. In general, a pretty free bleeding from 
the arm, sufficient to reduce the pulse, should be performed, 
the bowels should be freely purged by salts and senna, or mag- 
nesia, and if the acute symptoms be not relieved, leeches should 
be applied to the limb. 

The farther treatment of this tedious affection need not 
occupy our attention, for it should be left in the hands of the 
profession, and it is not of that urgent character which demands 
the risk of trusting to less informed advisers, eVen when medi- 
cal assistance cannot be had in reasonable time. Much good 
may be done by methodical bandaging, after the first violence 
of the disease is over; but errors in bandaging might be at- 
tended with evils worse than the complaint itself, and unfortu- 
nately, methodical bandaging, is not only above the skill of 
most domestic advisers, but is practised by too small a portion 
even of professional men. 

Of Puerperal Nervousness, Mania, and Melancholy. — As all wo- 
men are more irritable in the puerperal state, and more easily 
affected, both in mind and body, than at other times, they are 
not only more subject to inflammatory diseases, but occasion- 
ally become even maniacal, either a little before, during, or 
shortly after their lying-in, or, perhaps, after they have been 
nursing for some time. This attack of mental aberration often 
comes on suddenly: for example, the patient may awaken in 
terror out of an apparently sound sleep; or some trifling alarm 
may excite her very much; and, from that moment she may be 
more or less maniacal ; her wandering mind, still harping on her 
child. Sometimes she is conscious of her situation, and knows 
that she has a strong propensity for the destruction of her own 
offspring. A lady, who had been strongly attached to her infant, 
on one occasion, while nursing it, screamed to her nurse, " Take 
this child from me, or I shall throw it into the fire!" 

Under this mental obliquity, a pious woman will utter oaths, 
and use obscene language. In some instances, the derange- 
ment is evinced less in the language than in the irregular con- 
duct. There is, perhaps, most frequently, a tendency to 
raving rather than melancholy. The patient always recognises 
sorrounding objects, and either answers any questions ad- 
dressed to her, or allows^ herself to be disturbed by them. She 
sometimes reasons pretty correctly on her insane idea, and can 
be, for a little while, interrupted in her madness,, by her own 
efforts, or by proper management. Her face is commonly 
rather pallid, evincing trepidation and imbecility; her eye has 
a troubled appearance ; her pulse becomes frequent upon the 
slightest nervous irritation or bodily exertion: the tongue is 
generally white; the skin sometimes hot, particularly at the com- 
mencement of the attack; the secretion of milk is occasionally 



530 PUERPERAL NERVOUSNESS, MANIA, AND MELANCHOLY. 

diminished; excepting when there has been a previous at- 
tack of diarrhoea, the bowels are confined; and, in many 
cases, there is decided derangement of the functions of the 
liver. 

'There appear to be two forms of puerperal mania; one at- 
tended by fever, or a rapid pulse, the other accompanied by 
only a very moderate disturbance of the circulation; and it is 
the experience of some practitioners who have had charge of 
both kinds of cases, that most of the latter recover, while those 
with rapid circulation generally die. Mania soon after de- 
livery is more dangerous to life than melancholy beginning 
several months afterwards. If the patient can sleep, and her 
pulse becomes slower and firmer, even should her mind con- 
tinue disturbed, she may recover; but, on the contrary, if she 
have a quick, weak, fluttering pulse, with constant wakeful- 
ness, and symptoms of increasing exhaustion, she is likely to 
die, even though her mental condition may be apparently im- 
proving. It is a popular impression, that intellectual derange- 
ment is almost uniformly owing to excessive action of the blood 
vessels of the brain. While conceding the fact, that there is 
an inflammatory condition of the brain attended by delirium, 
and that too, often of the most acute kind, it must be borne in 
mind that the mania which attacks women whilst lying-in, or 
after nursing for some time, is generally one of exhaustion of 
the physical energies ; and that, while all moral stimuli should 
be carefully removed or guarded against, vascular depletion 
should be resorted to with extreme caution, if at all. Bleeding 
has often aggravated the symptoms, and has sometimes de- 
pressed the patient below the power of recovery. The bowels, 
being generally very much constipated, particularly in cases 
of attack' about the period of delivery, let them be thoroughly 
opened by some safe cathartic pills, or by senna and salts. If 
there be evidence of much disturbance of the biliary function, 
adminster a dose of five or ten grains of calomel alone, and 
follow it up next morning by rhubarb and magnesia, Epsom 
salts, or senna tea. After thus clearing out the alimentary 
canal, the bowels should be kept regularly excited by the com- 
pound rhubarb pill, or by the pills of aloes and asafcetida. If the 
patient be extremely restless and unmanageable, confine her mo- 
tions by the strait waistcoat, or by binding the elbows with a strap. 
Keep her room dark, and exclude her friends and all persons 
but a nurse who can exercise a proper influence over her, and 
her physician ; let her diet be nutritious, easily digestible, and if 
she have lost much blood by hemorrhage or otherwise, or if 
her disease have been produced by too long nursing, administer a 
small quantity of wine; say one or two ounces in the course of 
twenty-four hours. 



PALSY OF THE BLADDER SWELLED THROAT. 537 

In order to procure rest at night, the patient should take 
some anodyne article, such as twenty drops of hartshorn 
or acetic tincture of opium, or a grain of opium in. a solid pill. 

Thus far, on emergency, the domestic adviser may go; but 
if the disease continue unchecked or increasing, the farther 
treatment depends so much upon nice distinctions in the cha- 
racter of the particular case, and the feelings and disposition 
of the patient, that we believe it would be safer to leave the 
powers of nature to their course, than to place the very deli- 
cate subject under other jurisdiction than that of the profes- 
sion. 

Of Palsy of the Bladder. Some females, after the easiest 
as well as after instrumental deliveries, become the subjects 
of paralysis of the lower extremities and bladder. They are 
then incapable of evacuating the urine; and unless the blad- 
der be relieved by art, it would be liable to laceration. The 
catheter should, therefore, be introduced at least twice a day, 
during the whole continuance of the disease. The patient 
can soon be taught to use it herself. By the free use of fric- 
tions, tonics, and exercise, the disease generally goes off in a 
few weeks. Some nurses are instructed in the art of intro- 
ducing the catheter, which is a much easier and safer opera- 
tion in females than it is in males. 

Of Swelled Throat. In some peculiar constitutions, and 
from some peculiar causes, swelling of the thyroid gland (the 
gland which is the seat of goitre) takes place after parturition. 
It generally appears within a few days after delivery. Some- 
times the woman feels as though something had given way in 
her throat; the gland may swell rapidly and enormously, 
giving rise to great distress, and a suffocating sensation. Oc- 
casionally it becomes inflamed, and suppurates: at other times 
its growth is gradual. It may then remain for a time station- 
ary, or in an indolent state, giving rise to very little inconve- 
nience; perhaps merely a slight difficulty in swallowing. 

We have seen the sudden enlargement of this gland sub- 
side rapidly under the application of a number of leeches, and 
frictions with iodine ointment. Frictions with salt and wa- 
ter, repeated blistering, and the internal and external use of 
iodine, have been found useful in the chronic form of the en- 
largement; but the last named remedy is too dangerous to 
be trusted in unprofessional hands. 

Inflammation and Jlbscess of the Mamma. Almost al- 
ways on the second or third day after delivery, especially if 
the nurse have neglected the application of the child to the 
breast very soon after its birth, there occurs a sudden sensa- 
tion of fulness in the bosom, often ushered in by chill and fe- 
ver, with headach, dry skin, furred tongue, &c, particularly 

6S 



538 abscess or the mamma. 

if the diet or drinks have been stimulating, and the bowels 
have not been freely evacuated. The breasts soon become 
turgid, not only with milk, but blood; they are painful and 
throbbing, and, if not soon relieved, the pain extends to the 
arm-pits, the glands of which become sore, and the suffering 
is almost intolerable. In some women, this affection rapid- 
ly runs on to suppuration, and a part or the whole of the 
breast becomes involved in one extensive abscess. 

If this affection be treated early, before the symptoms run 
high, much mischief may be prevented by administering a 
brisk saline purgative, such as salts and magnesia, salts and 
senna, &c. ; bathing the breast with a sponge which has been 
saturated with warm vinegar, or applying a soft poultice of 
hops stewed in vinegar and water, and thickened with flaxseed 
meal or wheat bran, &.c, repeating this as often as it becomes 
cool; allaying thirst with toast water and sweet spirits of 
nitre, the latter in the amount of a tea-spoonful every hour or 
two, till free perspiration is induced; or refreshing the patient 
with soda powders or saline mixture, in small but frequent- 
ly repeated doses, till the febrile symptoms abate. The diet, 
during this time, should consist of a little thin water gruel, 
panada, or sago. 

If the fever be high, and the pain intense, accompanied by 
delirium, the patient should be bled from the arm, until a little 
faint; and if not decidedly relieved, twenty or thirty Ameri- 
can, or ten or fifteen imported leeches should be applied about 
the inflamed part, but especially at the lower edge of the tu- 
mefied breast — the bleeding from these should be encouraged 
by cloths wrung out of warm water. The purging should 
be kept up by a repetition of the salts or magnesia, if neces- 
sary. 

The inflamed breast should be frequently examined, espe- 
cially when the pain is of a throbbing kind, as abscesses are 
very likely to form deep in the substance of the gland, and if 
not soon opened, they sometimes form suppurating passages, 
running, to a great extent, under the surface. Generally, 
however, the abscess is more superficial, and readily points 
outward. If the abscess be small and superficial, it is common- 
ly deemed advisable to permit it to burst spontaneously : but 
when the disease is extensive, so much of the substance of the 
breast is liable to be involved, that surgeons prefer nuking 
an opening with a lancet as soon as the formation of pus can 
be ascertained. When the disease is deep-seated, involving 
the substance beneath the gland, great adroitness is requisite 
to discover the existence of pus, and the proper time and 
place for making an opening through which to evacuate it. 

Poultices of bread and milk, flaxseed, or powdered slippery 



INFLAMMATION OP THE NIPPLES. 539 

elm bark, kept soft by a proper quantity of sweet oil or lard, 
make decidedly the best dressings for this affection, until the 
abscess begins to heal, when it may be treated like abscesses 
in general. — See Inflammation, Terminations in Suppura- 
tion and Ulceration. 

Should the patient be much debilitated by the discharge of 
pus, we should sustain her by a nutritious diet, and even allow 
her a small quantity of good wine in her gruel or soup, till 
her constitutional powers become somewhat invigorated. 

Particular care should be taken, throughout the whole af- 
fection, to keep up, if possible, the secretory power of the 
gland: if this be neglected, the breast is apt to be permanently 
ruined, so far as regards its usefulness in supplying nourish- 
ment to an infant. Suction, gently but perseveringly applied, 
should either be made by the mouth of some attendant, or by 
a glass nipple pipe, or other suitable instrument. 

It unfortunately happens, that many who have had milk 
abscess to any extent, continue very liable to a repetition of 
the disease during subsequent confinements; and when this is 
not the case, the occurrence of even a slight cold is liable to 
reproduce a most painful swelling of the affected breast. 

The nipple is very apt to become buried in the substance 
of the breast ; or, if the abscess has opened very near it, it is 
liable to be drawn down in consequence of the contractions 
caused by cicatrization. 

Of Inflammation of the Nipples. The nipples are some- 
times the seat of excoriations, fissures, and occasionally of 
such high sensibility, that the mother is utterly incapable af 
suckling her child. 

This state of morbid sensibility may, or may not be attend- 
ed by a breach in the surface of the nipple. If carefully exa- 
mined, the extremities of the lactiferous ducts will appear 
erect, somewhat turgid, and the end of the nipple will seem 
to be granulated like a raspberry. Slight pressure upon any 
part of the nipple, will then cause a stinging sensation, which 
the patient will sometimes declare to you extends not merely 
into the breast, but up to the arm-pit; yet, when the nipple is 
protected from pressure by a proper shield, armed with an 
artificial teat, so that the child can draw freely, she frequently 
does not experience any pain. 

, If soreness of the nipples be attended to early, and the ge- 
neral health of the patient be good, it is easily cured, in most 
cases; and, at first, by simply washing with a little weak 
brandy, whisky and water, mucilage of gum Arabic, flaxseed, 
pith of sassafras, slippery elm, or quince seeds: but where it 
has continued several days, and the parts have become much in- 
earned, soft poultices with lead water should be applied imme- 



540 INFLAMMATION OF THE NIPPLES. 

diately after the child is removed from the breast, or a weak 
solution of nitrate of silver, three grains to the ounce of «r*» 
ter," may be applied to the fissures by a soft hair pencil, every 
day, till the surface is found to heal up rapidly. Great care 
should be taken to wash the nipple thoroughly, before the 
child takes the breast. Solutions of borax have often been found 
very useful, particularly when the sore nipples occur simulta- 
neously with the aphthous sore mouth in the child. There are 
some women, whose breasts are as round as a melon, and the 
protrusion of the nipple not greater than the blossom-end of 
that fruit; they have, indeed, apparently no nipple at all. 
This deficiency is generally charged to the account of tight 
lacing with corsets. Tight lacing with corsets is an abomina- 
ble practice, and often productive of much greater evil than 
depression of the nipples: but we aver, that we have met with 
this defect in middle-aged, well-grown, young ladies, who 
with singularly good resolution, have never worn corsets 
during life. With these, therefore, the defect has probably 
been congenital, and though it causes no inconvenience in the 
virgin state, produces much mental uneasiness to a mother: 
let her then set about the regular business of drawing out the 
centre of the areola on her breasts, by means of the common 
breast glass, or a smooth edged tobacco-pipe, upon which she 
may exert suction with her own mouth; or she may use the 
gum elastic bag, which, if applied in a compressed state, will 
keep up a constant and gradual draught upon it. In most in- 
stances, the nipple can be drawn out so far, that the infant 
can seize it with its mouth; after which, it can readily be 
formed into a regular, permanent protuberance. 



CHAPTER IV. 
ON DISEASES OF CHILDREN. 



Tongue-tie. Children, soon after birth, frequently expe* 
rience some difficulty in nursing; they either apply the mouth 
irregularly to the nipple, or take in so much of the breast as 
to distend the mouth, and a chuckling noise is made by the 
entrance of air, at its corners: this circumstance is often owing 
to the child being tongue-tied. 

The fraenum or bridle, which extends from the central line 
of the tongue to the bottom of the mouth, is either too short, 
or reaches so nearly to the point of the tongue, that the move- 
ments of the latter are very much restrained. Upon exa- 
mining the mouth, the point of the tongue is found bound 
down by a thin membrane, which is transparent and without 
blood vessels. When this band exists, the child is generally 
unable to apply the tongue around the nipple; for, at almost eve- 
ry attempt, the nipple is forced out of its mouth, until it be- 
comes fretted and fatigued. When this state of things exists, 
the child should be placed across the lap of the nurse, with a 
clear light falling upon the part; the membrane should be di- 
vided, either by a pair of sharp-edged, but blunt-pointed scis- 
sors, a gum lancet, or, what we have mostly preferred, a sharp- 
pointed bistoury, wrapped to near its point with linen. As a 
little carelessness may produce troublesome bleeding in this 
operation, it should not be attempted by any one wholly igno- 
rant of anatomy. 

The wound made by a proper incision generally heals with- 
out farther attention; but if, by accident, any vessels should be 
cut, and hemorrhage arise, it must be suppressed by the pres- 
sure of a dossil of lint, the application of some wheat or rye 
flour, a little powdered gum Arabic, or a little piece of alum. 
In some rare instances the tongue is bound down, and its mo- 
tions restrained by the extension of the fleshy fraenum almost 



542 SWELLED BREASTS — SORE NAVEL. 

to its very extremity. An operation in this case would be so 
hazardous, that nothing can be done with propriety until later 
in life. Fortunately this condition rarely prevents the child 
from sucking. 

- Swelled Breasts. Infants are sometimes subject to enlarge- 
ment of the breasts at the time of birth, or shortly after it Both 
mothers and nurses ascribe this condition to accumulations of 
milk in the child's breasts, and believe that it must be squeezed 
out to effect a cure! Hence they set about the process of milk- 
ing the poor little creature, who has probably not yet even 
milked its mother; by which folly the breasts are inflamed, 
and often seriously injured. A highly respectable medical 
author reports a case, in which such extensive suppuration 
followed this kind of treatment, that both breasts of his little 
patient {a female) were entirely destroyed! 

These swellings are tense, firm, and elastic; inflamed, and 
accompanied by an effusion of serum into the cellular mem- 
brane beneath the skin. If the inflammation run high, the 
central portions of the tumours assume a purple appearance. 
Though the affection is usually mild, it sometimes lasts nearly 
a week, even under the best treatment; but, unless roughly 
handled at the beginning, it very seldom terminates in ab- 
scess. Cloths, moistened with sweet oil, or a soft bread and 
milk poultice, changed every three or four hours, are highly 
useful; and the swelling and inflammation are said to be very 
rapidly reduced by the application of a warm lotion, composed 
of one drachm of the muriate of ammonia, (sal ammoniac) dis- 
solved in eight ounces of vinegar and water. When suppu- 
ration is threatened, a few — say two or four — American leeches 
should be applied to the parts as a preventive. 

Sore Navel. This complaint is frequently the result of 
carelessness in dressing the cord. Besides a deep-red appear- 
ance of the abraded surface of the navel, we find there is a 
spongy or fungous formation, which discharges a thin purulent 
offensive matter, and the patient suffers much distress and 
pain. The discharge is sometimes caustic, and inflames every 
part it happens (o touch. The fungous growth generally springs 
up after the cord has fallen off, but occasionally, also, while it 
is still adherent. 

In treating this affection, every irritating matter should be 
carefully removed. If any portion of the cord remain at- 
tached, it should be cut off close to the navel with sharp 
scissors, or a scalpel; then washed with milk and water, or 
flaxseed tea. If a fungous or polypous tumour exist, it should 
be destroyed by passing a fine silk ligature around its h 
after which it may be dressed with the Goulard's ointment, 
or Turner's cerate. If the fungus be disposed to shoot up 



YELLOW-SKIN AND JAUNDICE OF INFANTS. 543 

again, the powder of the Indian blood root, (sanguinaria ca- 
nadensis,) or a little powdered alum, should be dusted on the 
part, and the whole surface covered with lint, spread with 
either of the above named ointments. If the excoriation be 
extensive, and the discharge copious, washes of lead water, 
or oak bark tea, are very useful. If this fungous growth be 
broad at its base, it must be repressed by a solution of lunar 
caustic, (nitrate of silver,) say ten grains to an ounce of wa- 
ter, applied with a camel's hair pencil, until the parts begin 
to heal: if this do not succeed in a short time, a drachm of 
sulphate of copper (blue vitriol) should be dissolved in an 
ounce of water, and applied once or twice every day by 
means of a hair pencil or a little lint. Powdered galls, or 
oak bark, dusted on the part very frequently, will often suc- 
ceed in causing a healthful cicatrization. If the navel should 
exhibit an ulcerated appearance, surrounded by swelling, it 
may be relieved by a bread poultice, well moistened with 
lead water, and applied as long as there is any inflammation; 
after which, a solution of the sulphate of copper, of one-sixth 
the strength before mentioned, will commonly succeed. We 
repeat, however, that unremitting care should be used to keep 
the diseased surface constantly clean, and the surrounding 
parts dry and comfortably dressed. 

Of the Yellow-Skin and Jaundice of Infants. Most children, 
when three or four days old, exhibit a yellow state of the skin, 
for which the officious nurse would promptly administer the 
saffron or sweet marjoram tea, "very plentifully, with a view 
to keep out the yellow gum," and thus torture the child with 
a distended stomach more disturbing than even the disease, 
which, if left to itself, will usually pass off in a few days. Very 
young children are, however, occasionally subject to such se- 
rious derangements of the functions of the liver, as not only 
to occasion a deep yellow tint of the skin and the whites of the 
eyes, but also to impart the same colour to the urinary dis- 
charges, while the stools are pale or clay-coloured, from a 
deficiency of bile. 

The proper distinction between the common yellow-skin, 
which may be said to require no other attention than cleanli- 
ness, and the real jaundice, which manifests serious disorder of 
the internal organs, is this, that the yellow state of the skin in 
the first affection is unattended by any uneasiness, yellowness 
of the urine, or costiveness ; while, in the latter, the white of 
the eye is yellow, the patient is restless, fretful, vomits fre- 
quently, or exhibits symptoms of nausea, and is little inclined to 
take the breast ; the stools, when they occur, are whitish or 
clay-coloured, the urine stains the diapers, and very frequently the 
slightest pressure over the stomach or liver produces pain. This 



544 YELLOW-SKIN AND JAUNDICE OF INFANTS. 

last is an unfavourable sign. The latter train of symptoms 
will require prompt and skilful treatment. 

If the patient be free from fever and tenderness in the sto- 
mach or liver, two or three grains of powdered ipecacuanha 
should be given every ten or rifteen minutes until vomiting is 
produced ; and if the disease should be obstinate, this must be 
repeated every two or three days, till the stools assume a 
bilious or dark green colour. Avoid the use of emetics, if 
there be any marks of inflammation in the stomach, liver, or 
bowels. In any case, however, the bowels must be kept freely 
open, and the best purgative is calomel follovyed by magnesia or 
castor oil. We are much in the habit of administering the tenth 
or twelfth of a grain of calomel with half a grain of the bi-carbo- 
nateofsoda, and a little powdered gum Arabic, every hour until 
ten or twelve doses have been taken ; then if the bowels be not 
moved with bilious evacuations, we give a tea-.spoonful of cas- 
tor oil, or about as much magnesia. Our success with this 
practice has been so uniform in the course of a few days, that 
we rarely find it necessary to use any other medicine. It 
is frequently necessary to repeat the calomel and oil every 
few days, even after convalescence has commenced, for the 
purpose of keeping up the healthy action of the liver. The 
warm bath is highly recommended by some practitioners. 
Gentle frictions over the whole cutaneous surface are useful 
when there is no internal soreness. When intlammation of the 
stomach and liver is manifested by great tenderness under the 
slightest pressure, with fever and vomiting, accompanied by 
great anxiety and distressful features, four or rive American 
leeches should be applied to the part; or, if they cannot be pro- 
cured, an ounce or two of blood should be taken from a vein 
in the arm or leg. If this do not relieve the affection, spread 
a piece of leather or muslin with a layer of blistering ointment as 
thick as a wafer; then, with the blunt ed-:e of your spatula or 
knife, scratch a number of furrows in various directions upon 
the ointment ; till these fissures with common spirits of camphor, 
cover it with book or mul-muslin, apply it with a tolerably 
tight bandage to the skin, over the region of the liver; allow 
this to remain on about two hours, then remove it, and if the 
skin appear very red, lay this plaster aside, and dress the part 
with a soft poultice: repeat this poultice as it becomes cool or 
dry, and evacuate the blister as soon as it is formed. By this 
process the patient will experience very little pain from the 
blister, while the internal disease is very much relieved by it. 
If a troublesome and debilitating diarrhoea should occur after 
the disease has existed some days, half a grain of the bi-car- 
bonate of soda, and a quarter of a grain of Dover's powders, 
should be given, and repeated every three or four hours, until 



ON RETENTION AND SUPPRESSION OF URINE. 545 

the irritation of the bowels is allayed, and the diarrhoea 
arrested. When the jaundice has either been neglected, or 
has not yielded to the means already directed, two grains of 
the soda may be given with ten grains of the extract of dan- 
delion, dissolved in a little warm water, two or three times a 
day. If the little patient should suffer much from flatulence 
or spasmodic pains, let three or four grains of asafcetida be 
dissolved in about the same number of table-spoonsful of warm 
water, and used as an injection into the bowels: if this does not 
produce relief, give two or three drops of sulphuric ether, in a 
tea-spoonful of hop tea, keeping up at the same time gentle 
but brisk frictions on the back and abdomen, if the patient can 
bear them. 

On Retention and Suppression of Urine. It is the positive duty 
of the attendant upon new-born children to inquire into the 
condition of the bladder; for the urine is liable to accumulate, 
giving rise to great distention and distress. In general, a delay 
of fifteen or twenty hours is serious to the patient, whether it 
depend upon the want of secretion by the kidneys, or reten- 
tion in the bladder after the kidneys have done their duty. 
Where we have reason to suppose that the kidneys do not se- 
crete this fluid, they can be frequently excited into action by 
the administration of a few tea-spoonsful of parsley or wild 
carrot seed tea containing two or three drops of sweet spirits of 
nitre, every half hour. The child should be plunged into a 
warm hip bath, care being taken to have its bowels well eva- 
cuated. The external use of vinegar, squills, or a tea-spoonful 
of juniper oil, with two table-spoonsful of sweet oil, or the juice of 
onions diluted with water, will promote the object. A drop of 
spirits of turpentine mixed in milk, or four or five drops of 
onion juice mixed in the same fluid, may be given two or 
three times an hour till the" secretory process is established. 
This internal stimulant may be greatly aided by the frequent 
repetition of injections of warm water. 

The urine is occasionally allowed to accumulate and dis- 
tend the bladder very much ; in some cases without the escape 
of a single drop, at other times with a constant dribbling; so 
that although the diapers are continually wet, and the nurse 
inclined to believe that all goes on well, yet the bladder has 
been known even to burst, and the urine to be poured out into 
the cavity of the peritoneum. Nothing will afford relief until 
a catheter of proper size has been introduced by a skilful sur- 
geon. 

Painful Urination. — There is another serious inconvenience 
to which children are occasionally subjected: their kidneys 
may secrete freely, and the bladder contract promptly, but the 
patient shrinks from the inclination, in consequence of the pain 

69 . , 



540 FALtfFUL URINATION. 

experienced in the evacuation. The child will have occasional 
fits of violent shrieking or agitation, as though it had an attack 
of severe colic pains; upon attentive examination, however, it 
may, perhaps, be perceived that the uneasiness and pain are 
coincident with the discharges from the bladder: the urine it- 
self is almost always in an unhealthy condition in these cases: 
it generally contains too much acid, which irritates the deli- 
cate internal surface of the bladder and urethra. 

The treatment of this troublesome affection must be regulated 
by the following circumstances. U the diapers worn by the 
child should be tinged red by the urine, two or three grains of 
rhubarb, and double the quantity of magnesia should be given 
every few hours, till they open the bowels freely, which should 
then be kept regular by half a grain of calomel and one-eighth 
of a grain of powdered ipecacuanha, daily, till the digestive 
functions are restored. If there be eructation from the stomach, 
or acid odour in the discharges from the bowels, give three 
or four grains of the carbonate of potash, dissolved in a tea- 
spoonful of weak infusion of Columbo root, the whole diluted in 
a little flaxseed ten, or bailey or gum Arabic water, and re- 
peat it two or three times a day. If the skin be dry, perspira- 
tion should be promoted by the acetate of ammonia, sweet 
spirits of nitre, and the juice of onions or sirup of squills; but 
the regulation of these remedies must rest with the physician. 
Jf there be a strong disposition to form acid in the stomach and 
bowels, mild animal soups would be better as diet than any 
farinaceous articles. 

When, on the contrary, painful urination is accompanied by 
a free deposite of white or yellow sediment, and when the urine 
itself is pale, instead of red, the treatment must be reversed. 
The bowels should be emptied by castor oil or rhubarb; and 
half a grain of powdered valerian root, with one-fourth of a grain 
of Dover's powder, must be administered two or three times a 
day, to a child from a week to a year old. Its drinks must con- 
sist of lemonade, or water sweetened with lemon sirup, and 
from one to two drops of the tincture of the muriate of iron, may 
be given three times a day with considerable advantage. Beef 
tea or chicken water may be taken, if the child require any 
thing besides its mother's milk: no alkaline substances should 
be given, while this condition of urine continues. If the un- 
easiness be not attended by an unhealthy state of the urine, 
mucilaginous drinks may, perhaps, remove it. 

It is necessary to examine the condition of the urethra in all 
cases of painful urination, as much protracted suffering has in 
some cases been kept up, not so much by the morbid con- 
dition of the urine, as by inflammation at the extremity of the 
passage : female children are said to be more especially sub- 



DIABETES. 547 

ject to this state of things. Solutions of borax in water, or flax- 
seed tea, should be first applied as a wash to the inflamed sur- 
face. The watery solution of opium is sometimes a very 
soothing application. The parts should at least be kept con- 
stantly shielded from the discharges of urine by some lard or 
mild ointment. 

, Incontinence of Urine. — Some children continue to have in- 
voluntary discharges from the bladder, long after they obtain 
a control over the sphincter muscle of the bowels, to the 
great inconvenience of the mother or nurse, and to their own 
extreme mortification if the habit continue as they grow up. 

It is said that children are rarely known to pass their urine 
during sleep, unless they lie upon their backs. 

One part of the treatment is sufficiently obvious: and pro- 
per precaution in emptying the bladder before lying down, 
allowing the child to have but a small portion of fluid in the 
evening, would contribute much to the cure of this disgusting 
difficulty. The fear of corporeal punishment has sometimes 
operated favourably, by causing the child to sleep lightly, 
' and to be easily aroused by the slightest impulse to employ the 
bladder. There is much cruelty in this plan, as in some other 
remedies advocated by nurses of by-gone days, consisting in 
obliging the children to eat a disgusting breakfast every morn- 
ing after wetting the bed. If, however, a really morbid condition 
of the bladder exist, every effort should be made to invigorate 
the general health, as well as to strengthen or excite the uri- 
nary organs in particular. Cold bathing, free frictions with a 
piece of flannel, or a flesh brush, should be used; and the child 
should take from tw r o to five drops of the tincture of muriate 
of iron, according to the age, two or three times daily. In 
children over five years old, from one to three drops of the tinc- 
ture of the Spanish fly, according to the age, may be given two 
or three times a day, till it arouse the sensibility of the neck of 
the bladder, and cause a little pain in discharging urine. The 
free use of a decoction of the bear-berry leaves {arbutus uva 
ursi,) has been found effective in many cases of long standing. 
Excessive Urination, Urinary Consumption, or Diabetes. 
Another affection of the urinary organs, to which some chil- 
dren are subject, is an excessive secretion of urine, common- 
ly accompanied by considerable disturbance of the digestive 
functions, and some morbid changes in the character of the dis- 
charge. This complaint generally exhausts the strength of 
the child with great rapidity. In many instances the urine is 
quite clear; in some, it has a white deposite, or resembles 
chalk mixed in water; at other times, it is of a pale straw 
colour, and has even been noticed of a greenish hue. In 
some cases this discharge may be coagulated by heat; and it 



548 SORE MOUTH THRUSH APHTHA. 

is remarked that, when this coagulating substance is most 
abundant, the flesh and strength of the patient decline most 
rapidly. The little patient suffers from pains in the head, 
giddiness, and even mental disturbance amounting to tempo- 
rary delirium; and a stupid, sleepy state sometimes precedes 
an apoplexj', which concludes the scene. This disease occa- 
sionally comes on so gradually, that its daily changes are 
scarcely noticed; and extensive disorder of the digestive or- 
gans takes place before any attention is given to the patient. 
It has frequently been mistaken for dropsy in the brain, ma- 
rasmus, or general consumption, even by experienced medical 
men. When it has advanced considerably, it is very likely to 
terminate fatally. 

"We shall not attempt to describe the treatment of this dan- 
gerous and obstinate disease. The best medical aid must be 
obtairred as soon as possible; and, in its absence, nothing can 
be safely done farther than to keep up the action of the bow- 
els and skin, and to rid the stomach of improper accumula- 
tions by castor oil, small doses of the Dover's powder, and an 
emetic, when required, should there be no great tendency of 
blood to the head. Cientle stimulation of the loins by fric- 
tions with spirits of turpentine, and the use of uva ursi tea, 
are safe, and may prove serviceable. 

If the abdomen become tumid, and there be much irritation 
of the bowels, the patient's diet should be restricted to bar- 
ley water, rice water, oat meal gruel, or rye mush and milk; 
but if the digestive powers be still good, and there be no evi- 
dent affection of the bowels, beef tea, or chicken soup, may 
be added to the list. If the head appear to be affected, and 
the gums inflamed, small blisters should be put behind the 
ears, and kept running some days. The warm bath should be 
frequently used; placing the infant first in water about the 
temperature of the skin, and keeping it in the bath for fifteen 
or twenty minutes, gradually raising the temperature of the 
water to ninety or ninety -five decrees of Fahrenheit's thermo- 
meter. When taken out, the whole surface is to be wiped 
perfectly dry, and a dress of flannel should be constantly worn 
next the skin. 

Sore Mouth, Thrush, Aphthae. This is a very common 
disease amongst children, and almost certain to occur when 
there has been any marked irregularity in diet; the little crea- 
tures who have been drenched with nurse's teas, for colic, red 
gum, &c, being pretty certain to show a plentiful crop of 
aphthous eruption about the tongue and cheeks a day or two 
afterward. On the contrary, however, when due attention lias 
been paid to cleanliness, when the child has been sustained 
on the milk alone, and this fluid is of good quality, the aflee- 



SORE MOUTH THRUSH — APHTHJE. 549 

lion is rarely to be met with, and when it does occur under 
these circumstances, it is always easily managed. In its mild- 
est form, there is little, if any, manifest disturbance of the 
general system; there being merely a slight increase of the red 
colour of the lining membrane of the mouth and tongue, 
which is covered by white flakes, resembling curdled milk, 
scattered over the tongue and lips. But in graver cases, the 
child will show its indisposition by fretfulness, by an in- 
creased slavering, and hesitation in sucking. It appears dull 
and sleepy, but starts frequently from a doze, as if frightened, 
or in pain. Its breath will be acid, and flatulent eructations 
will occur sooner or later, with green, watery and griping 
discharges from the bowels. The child will now vomit up 
any substance taken into the stomach, and the milk it has 
swallowed generally returns, very soon afterwards, completely 
coagulated. The mouth will now be found hot, with its lining 
membrane deeply reddened beneath a thick layer of white 
flakes, resembling finely masticated new cheese. Connected 
with this condition of the mouth, there are usually severe irri- 
tation of the bowels, colic, and sour; watery discharges run- 
ning off almost constantly; the lower orifice of the bowels 
becomes also inflamed, and sometimes excoriated by these 
acid evacuations. The child loses flesh very rapidly, becomes 
very pale, and so sore is its throat' that swallowing would be 
scarcely possible, even were it inclined to take nourishment. 
In all forms of this affection, the borax is one of the most 
useful articles. When the disease is slight and confined to 
the mouth alone, borax and loaf sugar, in equal quantities, 
finely powdered, and applied upon the tongue, allowing the 
child to convey it to every part of its mouth by the natural 
movements of that organ, will generally cure the eruption 
very speedily. The bowels should be attended to, and if they 
be confined, as is frequently the case at the beginning of this 
disease, a few grains of magnesia should be given, till gentle 
purging is effected. If there be already a general disturbance 
of the system, and the bowels frequently moved by acid dis- 
charges, the borax should be combined with equal parts of 
powdered gum Arabic, and applied to the mouth; while small 
doses of magnesia and rhubarb, with a little valerian, should 
be given, in the proportion of four grains of magnesia to one 
grain of powdered valerian root, mixed in half a tea-spoonful 
of sirup of rhubarb, every three or four hours, till the dis- 
charges are corrected. If there be much irritation of the 
bowels, the little patient should be placed for five or ten mi- 
nutes in a bath of about eighty degrees of Fahrenheit's scale, 
then wrapped up warm and dry, and, if not composed, a drop 
of laudanum should be administered. If there be small thin 



550 SORE MOUTH THRUSH APHTHA. 

discharges, attended by pain or straining, a tea-spoonful of 
the following mixture should be given every two hours till 
the child is composed. 

Magnesia, 12 grains. 

Laudanum, 3 drops. 

Water, 1 ounce. 

With sugar enough to make it palatable. 

When the discharges are very green and abundant, a drachm 
of prepared chalk should be used instead of the magnesia, or 
if the child is pretty strong, the magnesia and chalk may be 
mixed together with the laudanum and sweetened water, as 
before directed. Lime water and milk, in equal quantities, 
may be given the child in tea-spoonful doses, three or four 
times a day, when there are sour stools without much loose- 
ness. 

It frequently happens, that if the disease of the mouth con- 
tinue unchecked for several days, the discharges from the 
bowels are not only frequent and watery, but streaked with 
blood. This may be relieved, in most cases, by giving three 
or four times a day a tea-spoonful of oil of butter, prepared 
by placing a small quantity of good sweet butter in the bot- 
tom of a vessel, pouring over it a pint or more of hot water, 
and skimming off the oil which then rises to the surface. 
Thick gum Arabic water, or the thick mucilage of flaxseed, 
slippery elm, or pith of sassafras, in tea-spoonful doses, ad- 
ministered frequently, will be useful in relieving this condi- 
tion of the bowels. 

While we have before remarked, that we consider the bo- 
rax the most useful of all local applications in this disease, 
we mean to confine its application to the white incrustations; 
but if these become yellow, or brown, we would rely more 
confidently upon the Armenian bole, rubbed up with an equal 
quantity of loaf sugar into fine powder — and dusted upon the 
mouth, in small quantities, every two or three hours. A de- 
coction prepared by boiling half an ounce of Peruvian bark 
in a pint of water, and given in doses of twenty or thirty 
drops every hour or two, is advisable, when the mouth is 
livid or ulcerated. 

When the lower extremity of the bowels becomes inflamed 
by the acrid discharges, the part should be well washed; first, 
with clean water, milk and water, or flaxseed tea: after which, 
it should be well anointed with lard, or Goulard's cerate. 
No diaper should be applied the second time, without being 
carefully washed. 



colic. 551 

If the child have not been weaned, it should be confined 
strictly to the breast for nourishment. The mother's diet, in 
the mean time, should be so regulated as to ensure the great- 
est amount of health in herself, and consequent purity of her 
milk: for this purpose, she should abstain from all spirituous 
or exciting liquors; she should eat plain animal food with stale 
bread, rice, &c, drinking water only at dinner. If the child 
have been previously weaned, its diet must be closely re- 
stricted to gum water, lime-water and milk, or chicken-water 
and beef-tea. 

The cruel practice among some nurses of rubbing the child's 
mouth with a rough cloth, charged with medicaments, should 
not be tolerated by any parent. 

Colic. Scarcely a child is born in the temperate zone, 
even in our day of refinement, but it must have a " little cat- 
nip tea to ease the wind," according to the opinion of the 
nurses, who have been slow to abandon the doses of " tiff" 
which their wise grand-mothers constantly administered, with 
as much seeming necessity as the good cottager would give 
pepper corns and a drink of cold water to the young turkeys, 
11 she did not know why, but because her mother used to 
do it." 

To be serious, however, children are, under almost any cir- 
cumstances, extremely liable to suffer from colic; as may be 
seen by their becoming suddenly fretful, drawing up their 
legs, and crying for a few moments, then becoming apparent- 
ly easy again, for a short time, then going through nearly the 
same course of symptoms, till there is a discharge of wind 
from the stomach or bowels. The distress caused by this 
flatulence is sometimes so great that the child screams vehe- 
mently, drawing up its legs, and then stretching them out 
again, forcibly and suddenly, its face becoming red and bloat- 
ed, while its abdomen is tightly distended with the flatus 
which is contained in the bowels. Some children will suffer 
greatly in this way, with occasional intervals, for some weeks; 
yet they will thrive, and become quite fat. In these cases, 
the bowels are rather costive than otherwise, and the colic 
comes on at some particular hour of the day, like an intermit- 
tent fever. This, however, is not the case with many of the 
subjects of severe colic, as there is very commonly a more or 
less serious derangement of the digestive organs, attended by 
grass-green or slimy stools, frequently containing undigested 
food. The eructations sometimes bring on vomiting of hard 
clots of sour milk. When this is the case, the child will often 
be thin and puny. v 

Colic unquestionably, in many cases, depends upon some 
ill quality, or excess of quantity of the food taken. When 



552 OPHTHALMIA — SORE EYES. 

irritating purges are given to new-born children, weakened di- 
gestion and colic are almost sure to ensue. Great distention 
of the child's stomach, — even with molasses and waler, manna 
tea, as a purgative, or the large doses of other teas which are 
too frequently given for the rash, — is highly prejudicial. 
Improper exposure to cold air, with insufficient clothing, is 
another frequent cause of colic. Gruel, panada, soaked crack- 
ers, &c, which are too often given, even to very young chil- 
dren, will commonly occasion colic, with vomiting, green 
watery stools, and other disturbances. The milk of the mo- 
ther, from improper diet on her part, may give the child se- 
vere colic. Sudden frights, the strong sensation produced by 
some painful intelligence, or even a painful affection of the 
nerves of the face of the mother, have been known to cause 
colic in children, and require, in the two former cases, the re- 
moval of the child from the breast, and in the latter, the ex- 
traction of carious teeth. 

Children often suffer from colic, induced by inattention to 
the speedy removal of the diapers of the child, after evacua- 
tions either from the bowels or bladder. 

The mild forms of colic can generally be removed by 
wrapping the child warmly, briskly rubbing its back and ab- 
domen with a warm dry hand, changing its position, and al- 
lowing it to lie with its abdomen upon the nurse's lap, while 
gently agitating its whole body upon the knee. Should it 
continue to evince pain, a tea-spoonful of warm infusion of 
fennel seed, or annise seed, may be given at intervals, of five 
or ten minutes, till five or six doses are taken. Beyond this 
amount, if the child be very young, no liquid should be given. 
A table-spoonful of milk of asafcetida, as an injection to a 
small child, will sometimes be attended with benefit. Opium 
in almost any of its forms, should be avoided as long as pos- 
sible — as it is very liable to constipate the bowels, and also 
operates unfavourably upon the brain. Paregoric, laudanum, 
and the various carminatives, and " colic tinctures/' are all 
hazardous remedies. The laudanum, particularly, is often re- 
duced in strength, by the dishonesty of some apothecaries, 
until children "liuve been nearly or quite destroyed, by using 
that which is properly made, in doses to which they have 
become accustomed when employing that prepared by unprin- 
cipled but cheap dealers. 

Two or three drops of sweet spirits of nitre in a tea-spoon- 
ful of water, will often relieve obstinate colic; but if all the 
means pointed out should fail, a trust in Providence will 
prove safer than that jn nostrums or popular remedies where 
physicians cannot be had. 

Ophthalmia — Sort Eyes. Thi* is a troublesome affection 



OPHTHALMIA — SORE EYES. 553 

which many young children are subject, from a variety of causes. 
It generally shows itself from the second to the eighth day, 
and is first observed, by the adhesion of the eyelids, which are 
slightly swelled and red. On separating the lids, the eye-ball 
itself appears red and thickened. In a day or two the swelling 
of the eye-lids increases, and a thick matter escapes from be- 
tween them ; the child is very fretful and keeps its eyes closely 
shut. Unless the disease be arrested at this stage, it will in- 
crease so rapidly that the membrane covering the eye-ball be- 
comes intensely red and swelled, as if filled with bloody water. 
The discharge is now so copious, that it will frequently burst 
out from between the lids and run down in a stream upon the 
child's cheeks, inflaming the skin wherever it travels. If the 
disease be not promptly checked in its progress, the eye-lids be- 
come everted, the cornea may ulcerate and the humours of the 
eye run out. 

In some cases this disease is confined to the eye-lids alone, the 
ball not being affected. This case is usually as difficult to cure, 
though it is much less dangerous to the safety of the eye, than 
the other. 

In the early stage of the red, sticky condition of the eye-lids, 
we have generally found, that washes of flaxseed tea, carefully 
strained and poured on the eyes several times a day, answer a 
good purpose ; after which a few drops of rose water have ge- 
nerally completed the cure: but when, from neglect of the first 
stage, the inflammation has run high, attended by much swell- 
ing of the eye-lids and discharge of pus from the eye-ball or 
lining of the lids, soft poultices of bread and milk, containing a 
small quantity of lead w T ater, should be applied over the eyes, 
and renewed as often as they become dry or hot, — the lids should 
be drawn open occasionally, that the hot fluid may escape, and 
this should be instantly washed away by a thin mucilage of flax- 
seed, quince seeds, slippery elm, or, what is better than all, the 
pith of sassafras. If marked relief be not obtained from this 
treatment, two or three common sized leeches should be applied 
to each eye, or to the temples; the blood should be encouraged 
to flow from the bites after the leeches fall off, by soft cloths 
dipped in either of the above named mucilages, (made warm,) or 
by soft bread and milk poultices, which must be changed as often 
as they become bloody : .afterwards the eyes may be washed, or 
rather wet frequently with a very soft linen rag, saturated with 
a solution of two grains of sugar of lead in an ounce of rose 
w r ater. The little patient is to be kept constantly in a dark room ; 
and the eyes protected from compression by bandages: its diet, of 
course, should be confined to its mother's milk, or to two parts 
of cow's milk with one of water, and a little sugar: its bow- 
els kept loose by half a grain of calomel, and one grain of cal- 

70 



554 COSTIVENESS. 

cined magnesia, given every morning and evening in a little 
milk, or in sirup. These doses must be increased or diminished 
according to the effect on the bowels. Should not the disease 
become much lessened in a day or two by this course, the 
same remedies must be repeated till the violence of the in- 
flammation is moderated; after which the cure can generally 
be completed, if chronic inflammation continue, by the applica- 
tion of a small blister to each temple, or to the back of the neck, 
having them kept open for several days by dressing with ba- 
silicon, or even weak savin ointment. As soon as the eye-lids 
can be raised in a very faint light and the discharge has become 
thin, they may be washed with a solution of a grain of acetate 
of zinc to an ounce of rose water, four or five times a day. 
The eye-lids should be kept from adhering to each other by a 
little mucilage, or a few drops of the mother's milk, or a little 
fresh butter every evening. 

If ulceration of the cornea should unhappily occur, and the 
humours of the eye be poured out, the patient's system most be 
supported by bark tea and mild anodynes. One of the most 
frequent and terrible consequences of this affection is opacity 
of the cornea, which is rarely curable. That must be a very 
strong necessity, therefore, which should compel the domi 
adviser to tamper with the case; especially, as the more ener- 
getic mode of leeching recommended in the article on ophthal- 
mia, in the surgical part of this work, gives to the adroit sur- 
geon an almo>t absolute command of the disease, but cannot 
be employed on young children by any other person. 

Costivencss. The apprehensions of a mother or nurse arc 
very commonly aroused, upon the discovery that; the child's 
bowels arc cither rather sluggish ov very much constipated. 
While we would not wish to lull them into any false security 
on this subject, and thus induce them to become indifferent to 
such a condition of the child's system, they should be aware 
that children do occasionally remain for several days in a state 
of perfect health, without any evacuation from the bowels. 
While, therefore, the child continues to thrive and is cheerful, 
we would advise them to leave the case to nature; — but. 
general rule, children within the month usually evacuate their 
bowels from two to six times in twenty-four hours: after that 
time, once or twice. We should carefully inquire into the - 
of the intestinal canal upon the occurrence of any indisposi- 
tion ; such as flatulence, fever, stupor, or thrcatenings of con- 
vulsions. 

Very simple measures arc sometimes sufficient to excite the 
bowels into healthy action : a small quantity ot the West India 
molasses with water; a little manna tea; sweet oil and mo! i 
of each, half a tea-spoonful, given every three or four hours. 



VOMITING. 555 

will often procure free discharges. A tea-spoonful of warm 
castor oil, given alone, or from one to two tea-spoonsful of fresh 
calcined magnesia, thoroughly mixed with milk, may be given 
from the age of a month to that of two or three years. Ano- 
ther valuable remedy for habitual constipation in children be- 
yond six months old, is a thin gruel, made by boiling well a 
small portion of unbolted wheat flour, and straining it through 
a sieve while hot : this may be sweetened with molasses, man- 
na, or brown sugar, and made an article of diet for the child. 

Among the best injections arc, one or two ounces of molasses 
and water, oil and water, or Castile soap and water: among 
suppositories, a small piece of hard brown soap, cut in pro- 
per length and rolled round, a little pointed at one end, dipped 
into warm water till its surface is slightly dissolved, and then 
passed into the rectum a quarter of an inch within the anus, — 
or small pieces of tallow candle, or molasses candy used in the 
same way. A very common source of constipation in infants,, 
is the abuse of laudanum, either given injudiciously in colic or 
other diseases, or by nurses in the unprincipled practice of 
" keeping the child quiet," by the use of a violent poison. 

Vomiting. — Children generally possess the pow r er of throw- 
ing off' from the stomach with great readiness any excess of 
food which they may have drawn from the breast, or which 
may have been injudiciously poured into them by the nurse. 
This is a happy provision of nature, to prevent injury to the 
extremely delicate digestive organs of an infant, who has not 
instinctive perceptions with regard to the amount which its 
little stomach can manage; while it is too common a habit 
with those who supply the child with food from a spoon, lite- 
rally " to fill them up to the chin " before they desist. We. have 
not un frequently been pained to see spoonful after spoonful, 
poured into the oesophagus of' a child stretched out upon its 
back in the mostjresistless attitude, till the escape of the fluid 
at the corners of the mouth, gives the signal for raising it up, 
and jolting it on the knee till they have "settled it," and then 
the. same process repeated, till, happily for the child, the sto- 
mach vomits it up. Could this satisfy the nurse, perhaps no 
great harm would be done; but, "lest the poor little thing 
should starve," its stomach is again replenished in the same 
manner, till the nurse becomes wearied with her toil, and al- 
lows it a little rest. What better can be expected, than sour 
vomitings and griping stools, after the organic functions of a 
child have been so severely persecuted? 

The vomiting of children, especially when it takes place soon 
after free nursing, and the milk comes up unchanged, requires 
no other attention on the part of the mother than to pre- 
vent the child from sucking too much: let her then take the 



556 VOMITING. 

child away from, her breast, as soon as she perceives that it 
" begins to dally with the organ, or when it ceases to draw as 
though it were gratifying a necessary and proper appetite." 
-Then keep the child quiet for some time, not jolting or tossing 
it about, and thus agitating its stomach. But children may 
have vomiting from causes similar to those which affect adults, 
and then, careful, prompt treatment, will be necessary. Thus, 
the suppression of any habitual discharge from the skin, as 
that from sores behind the ears, perspiration, &c, or a confined 
state of the bowels, may give rise to this complaint ; severe falls, 
bruises, the accumulation of bile or acid in the stomach, <Lc, 
produce sympathetic vomiting. The stomach is common.; 
Jieved simply by removing the cause. If the vomiting should 
be brought on by the presence of noxious substances in the 
stomach itself, the effort to throw these ofF should be encou- 
raged by copious draughts of warm water, weak warm camo- 
mile tea, or common tea, till the disturbing; cause appears to 
be removed; after which two tea-spoonslul of common salt 
should be dissolved in four ounces of warm water and thrown 
up into the bowels; and this injection should be repeated 
every half hour, till it procures a full discharge. If this do 
not quiet the stomach, six or eight drops of laudanum may be 
diluted in a table-spoonful of warm water and salt, and used 
as an anodyne injection, for a child between six months and 
one year old; giving it, at the same time, two tea-spoonsful 
of lime water and milk, every hour by the watch. When 
the child appears to be in pain before the attack of vomit- 
ing comes on, much advantage may be derived from the 
use of the " spice bag," in addition to the other means. It is 
made by mixing together powdered ginger, cinnamon, allspice 
and cloves, a tea-spoonful of each, putting them into a thin 
iiannel bag about the size of an adult hand, and quilting these 
powders into the bag by a few stitches, to prevent them from 
being pressed up into a heap. Lay this bag on a plate or 
saucer, and pour over it a quantity of warm brandy or spirits, 
sufficient to saturate it, then apply it upon the skin over the 
stomach: when it becomes cold or dry, let it be saturated 
again and again. A most essential advantage is usually de- 
rived from this application. 

If vomiting be caused by the superabundance of acid gene- 
rated in the stomach, the milk is thrown up in a completely 
curdled state. If the curd be very hard, it is because the acid 
is very abundant. A looseness of the bowels generally attends 
on this state, if the child be teething : but at other times it is 
costive. If loose, — the lime water and milk, as before directed. 
two grains of bi-carbonate of soda with a little powdered gum 
Arabic, or a tea-spoonful of the common ohalk mixture may 



ERYSIPELAS. 557 

be given every two or three hours; and, if necessary, half a 
drop of laudanum may be combined with each dose of either 
of these prescriptions, until the irritation of the stomach and 
bowels is quieted. On the contrary, if the bowels be consti- 
pated, a tea-spoonful of fresh calcined magnesia should be 
mixed with ten tea-spoonsful of milk or water, sweetened with 
a little sugar, and a tea-spoonful of the mixture given every 
hour, till it operates. If the torpor of the bowels be very 
great, the saline injection mentioned already should be given 
to aid the purgative action of the magnesia: lime water and 
milk may be taken in tea-spoonful doses very frequently, if 
there be much thirst. If the child appear to be feeble, and 
without fever, ten grains of the the bi-carbonate of soda may 
be dissolved in an ounce of weak Columbo tea, and a tea- 
spoonful given every hour. 

When the child, after having been nursed at the breast, ap- 
pears to be pale and distressed for some time, and then, in a mo- 
ment, vomits up the milk unchanged and with great force, there is 
reason to suspect a deficiency of the acid necessary to effect 
the change which is preparatory to complete digestion. Under 
these circumstances it is necessary to supply the deficiency ar- 
tificially, by giving the child a small quantity of lemonade, oc- 
casionally, which must be discontinued, as soon the milk is 
found coagulated upon being vomited. If the child have been 
weaned when attacked with vomiting, its diet should be care- 
fully attended to, and it will frequently be found necessary to 
allow it chicken water, with its common farinaceous food. 

Erysipelas. Some children become the, unfortunate subjects 
of erysipelas soon after birth. A few instances are recorded, in 
which they were born with patches of this kind of inflamma- 
tion, which had advanced so far as to present vesications, and 
even gangrenous spots. When it does attack children, it is 
generally shortly after birth, say from the first week to the 
third month, and commonly commences in the form of a red 
blotch, on the lower parts of the body, groins, hips, navel, or in- 
side of the thigh. It is painful from the beginning, and is swelled, 
dark red, or purple, with an irregular surface. Within the 
first twenty-four hours, small blisters may often be seen scat- 
tered thinly over this inflamed part, though some cases run 
through their whole course, without a single blister being 
formed. Rapid vesication coming on shortly after the com- 
mencement of the disease, is a very unfavourable symptom, as 
there is then a strong disposition to mortification : this is more 
particularly the case when the disease happens to affect the 
abdomen. When it is seated on the limbs, or about the hips, 
it is. more likely to occasion ulcerations from destruction of the 
cellular substance beneath the skin. This disease and its con- 
sequences have been described in the second chapter of the 



558 DENTITION. 

second part of this work. The course of the complaint is nrucfr 
more rapid in infancy. 

In some cases, the affection is easily managed, giving way 
in two or three days without any unpleasant consequences. J t is 
always, however, to be watched with solicitude, as some cases 
- which appear mild and local at first, spread very rapidly over 
various parts of the body. We have seen it attack one arm. 
and thence traverse the whole body regularly: even when 
we hoped that it was completely subdued, we had the morti- 
fication to see it re-commence, and travel over precisely the 
same surface, till it destroyed the child in the course of ten 
days. Sometimes, however, it leaves one place suddenly, and 
attacks another remotely situated from it. Some children 
have attacks of erysipelas, whenever they happen to receive 
the slightest wound. 

Children in all situations, are occasionally subject to this dis- 
ease; but those who are nursed in ill-ventilated apartments' 
are especially so. We cannot regard the treatment of this af- 
fection as a suitable subject for popular directions. 

Dentition, or the process of growth of the primary teeth, does 
not often, in itself, involve any hazard to the child; but it is 
universally remarked, that, at this period, the system is by 
far more excitable, and that ordinary disorders make much> 
more impression on the health than at any other. The mecha- 
nical obstruction which the firm membrane covering the gums 
gives to the ready passage of the tooth in some children, does 
occasionally involve the little patient in great local pain, as- 
well as severe sympathetic irritation, c; ver, hcadach, 
sometimes inflammation of the brain resulting in dropsy, or 
producing disturbances of the nervous system, from a slight 
start in the sleep, to the most terrific convulsions, which may 
terminate in sudden death. 

In mild cases, when the child has been well nursed, almost 
the only affection attending the process of teething is some 
slight rash, or eruption. None of these eruptions are dangerous 
to the child's health, if not interfered with, and the officious 
meddler will often pay dearly for his temerity, in attempt:: 
dry up an eruption on the skin behind the ears, the top of 
the head, or any portion of the external surface. We have 
seen, diarrhoea, bloody stools, fever, convulsions, and drop>v of 
the brain terminating in deatji, where the mother, contrary to 
our counsel, anxious to remove an unsightly eruption on her 
child's head, anointed the sores well with the red ointment. 
which a female friend had assured her could not hurt the child. 
This, we believe, to be the history of hundreds of fatal cases of 
dentition; and our experience on this subject, is sufficient to 
warrant us in giving instructions positively, and in a few words. 

Keep your child clean by proper and frequent ablutions. 



DENTITION. 590 

and changes of dress, especially next the skin. It is folly to 
-neglect its flannel, muslin, or linen shirt and under dress 
for a week or longer, while its over dresses are changed al- 
most hourly, upon the arrival of every new visiter ! Daily 
changes in the under dress, are far more important to the 
■health of the child. Keep it upon such diet as has been found 
to agree with it, and almost uniformly this is the mother's 
milk, if she have it insufficient abundance. Wait until the 
process of dentition is complete, before you tax the child's sto- 
mach with digesting solid or crude food. When the child 
slavers fully, and you perceive it strongly disposed to bite hard 
•substances, procure an ivory, or what is better still, a gum 
elastic ring, one-fourth of an inch thick, and two inches in 
diameter, so that the child cannot swallow it. Let it press its 
"gums at pleasure upon this, and generally you will soon find 
the teeth protruding. If the child be feverish, without appa- 
rent reason, and if the gum be swelled, even if there should be 
no very certain sign of the approach of a tooth, you will be 
justifiable in cutting the gum. For this purpose lay the child 
horizontally with its head upon your knee, having the hands 
held by an assistant: depress the lower jaw firmly, apply the 
sharp edge of your tooth lancet, or a pen knife with the edge 
chiefly covered by winding cotton or silk around it, upon the 
gum over the seat of the tooth ; then, carefully removing the 
lips and tongue by interposing the ringers, cut freely down 
upon the tooth. This operation will give little or no real pain 
to the child. When the tooth lies Very deep, we need not at- 
tempt to reach it. Should there be much bleeding, the pointed 
end of a piece of alum passed over the wound, will generally 
arrest it. Let the condition of the bowels be carefully watched. 
A gentle diarrhoaa is often established by nature, when there is 
no sympathetic cutaneous disease. This must not be stopped, 
but only regulated. If it appear to be prostrating the powers 
of the child by thin watery, copious, and frequent evacua- 
tions, it will require prompt and skilful medical care. The diet 
should be the mother's milk exclusively, or thick gum Arabic 
water, rice water, barley water, &c. When the cutaneous 
eruption becomes troublesome, it is to be relieved by washes of 
tepid flaxseed, slippery elm, or pith of sassafrass tea, and the 
bowels regulated by the magnesia, or castor oil, when costive. 
Children, as well as adults, often find much relief to the itching 
and burning in the skin, by dusting upon its dry surface a little 
powdered starch, arrow-root, rye meal, or flour. This should 
never be done when the skin is broken, and a discharge issuing 
from it. Let the child's mouth be washed every morning, or 
more frequently, with cold water ; and if it have no fever, let 
it be carried out into the open air every day, hi suitable wea- 



560 DENTITION. 

ther. The child's head should be kept cool by day and by 
night, and it should dispense with wearing caps, and sleeping 
on soft pillows. 

If convulsions occur during dentition, the gums should be 
promptly and freely lanced over the spot at which a tooth pre- 
sents itself. This is most likely to happen, when the molar, 
eye, or stomach teeth are about to come through. It is espe- 
cially necessary, at this period, to watch the child carefully, 
and to avoid all irritating articles of food. The bowels should 
be kept open by calomel, castor oil, or magnesia. Three or 
four grains of the former, followed in an hour by a dessert- 
spoonful of oil, or a tea-spoonful of magnesia, mixed in a little 
rnilk or sweetened water, will be likely to purge freely. Im- 
mersion of the whole body, for fifteen or twenty minutes, in a 
bath heated to ninety degrees, — if practicable, will be very ser- 
viceable in the spasrn. 

The foot bath of the same temperature wifl act as a partial 
substitute. Poultices of onions, well stewed in vinegar and 
water, with the addition of a little flour of mustard or Cayenne 
pepper, or even soft bread with the mustard or pepper, applied 
to the ankles or soles of the feet until the skin becomes red, 
will be useful on this occasion. When the bowels have been freely 
opened, a table-spoonful of strong asafcetida tea should be inject- 
ed into the bowels, if the spasms be not already relieved. Should 
the case prove obstinate, and not manifestly relieved by the 
treatment already proposed, or if the child's face appear flushed, 
two or three American leeches should be applied to each tem- 
ple, and the blood encouraged to flow till there is a little pale- 
ness. Next, if necessary, should be a pair of small blisters ap- 
plied by narrow bands o( adhesive plaster to the bare space 
behind the ears, or a 'blister may be put on the back of the 
neck. Cool drinks, and light nourishment, as rice, barley, or 
arrow root water, should be given occasionally. Cold cloths, 
or a bladder one-third rilled with cold water, with all the air 
excluded, that it. may fit like a cap to the head, should be kept 
applied during the continuance of the disturbance of the brain, 
removing it for a short time every five or ten minutes, that it 
may not endanger the freezing of the scalp. It sometimes 
occurs, that the gums at about the period of dentition become 
ulcerated. If the tooth has not come through this spot, it is 
proper to cut down upon it, and then touch the ulcer with a 
solution of six grains of the sulphate of copper, in an ounce of 
water, applying it upon the ulcer by means of a camel's hair 
pencil, or a dossil of lint saturated with the solution, and taking 
great care that the child does not swallow any portion of it. 
It may be washed ofTin a few moments with clean water, and 
the application repeated twice a day. 



worms. 5G1 

Worms. — We have treated of worms in a preceding chap- 
ter, and we introduce the subject here, merely to protest 
against a popular opinion amongst nurses and some mothers, 
that those children whose health is not in every respect per- 
fect, are afflicted with worms, and consequently, that the poor 
child who rubs its nose, or has any irregularity in its appetite, 
is to be well dosed with worm lozenges, worm tea, Swaim's 
vermifuge, or some other of those celebrated nostrums which may 
be known to the superintendent of the child's welfare. As 
many causes operate in producing the above symptoms, and as 
they very often yield readily to other medicines skilfully ad- 
ministered, while the reputed -worm medicines are often given 
without any manifest discharge of these vermin r we feel safe 
in declaring that there is no positive proof of their existence, 
until they have been seen expelled from the bodies of children. 
For the treatment then proper, we refer to the article worms, 
in the second chapter. 

On Convulsions. — Many children, even when very young, are 
subject to sudden and rapid muscular movements; they will 
start in the nurse's lap, as though suddenly surprised with dan- 
ger of falling; their eyes will sometimes exhibit a quickness of 
movement or a squinting direction, which is calculated to ex- 
cite much apprehension in the minds of those about them. As 
the children increase in age and size, however, this mobility 
generally becomes tranquillized; but if they be fed with 
unsuitable food, such as pap, boiled crackers, &c, whilst very 
young, or be indulged in solid food, or crude fruit, when a 
little older, convulsions and death may follow. 

An attack of these "fits" is very frequently preceded by 
dulness, stupor, or restlessness, and slightly irregular move- 
ments of some part of the child ; as the clenching of a hand, 
and unnatural motion or fixedness of the eye; some distortion 
of the lips; a forcible gnashing of the gums against the nipple, 
while sucking, and a rigid closure of the mouth, so that it can 
scarcely be opened by force; then, a suspension of all action for 
a few moments, except, perhaps, a quick motion of the eyes and 
muscles of the mouth. Presently the child becomes very rest- 
less, again all the former symptoms present themselves, till the 
whole body is completely convulsed, the mouth foams, and 
the little creature soon sinks again into a state of tranquillity, 
from an exhaustion of its physical powers. 

The treatment of these cases must be left to the profession, 
unless under very peculiar circumstances, and in such situa- 
tions as that of the missionary in a savage country, the pioneer 
in the wilderness, and the captain of a transport or convict- 
ship at sea without a surgeon. We can offer no better advice 
than to follow the general directions given under the head of 

71 



562 DROPS* IN THE TRAIN. 

convulsio?is in a preceding chapter, (p. 481) with an appro- 
priate diminution of doses. 

Dropsy in the Brain is a disease which very often comes 
on gradually, and almost imperceptibly; commonly beginning 
in the same manner as convulsions. The child is wakeful: 
or, if it sleeps, it grinds its teeth, and often starts or rouses up 
suddenly, alarmed and screaming. Its bowels become irregu- 
lar, and the discharges have an unnatural appearance: they 
are often green, slimy, or watery, and streaked with green 
and pale coloured matters. The countenance is usually pale, 
and anxious or disturbed. Sometimes there is a red spot or 
flush upon one or the other cheek: the eye-brows are knit into a 
peculiarly unpleasant frown; the eye-lids are half shut when- 
ever the child is exposed to the light. 

Children, who can speak, complain of pain in the forehead; 
and even small infants indicate suffering in that place, by a 
constant disposition to apply the hand upon the head. As the 
disease progresses, vomiting occurs, and becomes very fre- 
quent, especially when the child is set upright. It is very 
restless, and tosses its head from side to side, evincing much 
suffering by its groans or whining expressions. Its skin is 
dry, and generally rather hot; the pulse is frequent and hard, 
but not full; the tongue is seldom coated, but, when so, its 
edges arc pale, and the fur is in the middle: when, however, 
the bowels arc much disordered, it is covered with a thick 
brown coat, which, after a time, becomes dry and rough. Soon 
after this, the child appears dull and stupid, regardless of sur- 
rounding circumstances, and inclined to sleep constantly. 
There is not only a general inactivity, but also a palsy of one 
or more extremities, by which it is rendered motionles-. 
cept a slight twitching of the toes or fingers: one or both 
may now be observed to squint: and either remain fixed, or 
be in constant motion. The lids themselves become palsied; 
the upper one falls over the eye, and partially closes it. while 
the lower one declines towards the cheek, and remains con- 
stantly open, giving a most ghastly look to the whole counte- 
nance. 4'hc pupil of t he eye may be found either unnatural- 
ly contracted or dilated: convulsions soon follow, and, after a 
lingering indisposition, close the scene: the body having, in 
some instances, been reduced to a state of complete emacia- 
tion. 

Except in the very early stage of this disease, we believe little 
can be done for its cure, or even essential mitigation. The af- 
fection often creeps on so insidiously, that it escapes the ol 
vation of even the anxious mother. Sometimes the first thing 
known is the convulsion. 

The fever should be kept down by such means as invite the 



DROPSY IN THE BRAIN— WHOOPING-COUGH. 563 

blood away from the brain; and for this purpose the bowels 
should be purged by a few (from two to five, or six,) grains of 
calomel, followed by rhubarb, magnesia, Epsom salts, or cas- 
tor oil: these must be repeated every day or two, until the 
discharges are more natural. During all this time the most 
simple diet only can be allowed the patient, such as boiled 
milk, barley water, arrow-root, rice water, &c. Should the 
patient be cutting teeth, the gums must be examined and, 
if swoln, lanced. If any sore behind the ear have been re- 
cently dried up, it must be again opened by a blister. A free 
bleeding from the arm will be necessary; and afterwards, leech- 
es to the temples and back of the head, or cups to that part 
and the back of the neck. 

We once saw a most happy change effected in a child about 
three years old, who was just passing into the sleeping state 
with this disease of the brain, by having its head shaved and 
covered over with leeches, allowing them to draw until the 
child became faint; they were then stripped off, and the child 
was carried out into the air. In less than twenty-four hours, 
it began to recover, and in a short time was entirely well. 
Our experience is, therefore, rather more in favour of free 
bleeding with leeches than bleeding from the arm alone; but 
in whichever way it may be done, — to be of any service, it 
must be done freely. Keep the extremities warm, the bowels 
open, the head cold, the room dark and quiet, and avoid ex- 
hibiting any thing which would call for the action of the brain 
whilst its delicate coverings are so much inflamed. After 
bleeding and purging, the Dover's powders are thought to be 
useful in quieting the patient, and disposing to perspiration. 
We think, they should be given with caution; and the head, 
at the same time, should be covered with a cap wrung out in 
cold water, and its temperature constantly kept under. A 
blister behind the neck might be useful after the system has 
been sufficiently reduced by bleeding and purgatives. 
" Of Whooping-Cough. This is an affection to which chil- 
dren are subject at some period of their existence; and one, 
also, which is not confined to infancy or childhood, though by 
far most common in these stages of life. It usually begins as 
an ordinary cold, or catarrh, at first without fever, and after 
continuing some days, during which it gradually increases in 
severity; a peculiar ivhooping sound is caused by the passage 
of the air through the spasmodically contracted windpipe in in- 
spiration. The child's face becomes flushed and almost pur- 
ple from the exertion in coughing, till the stomach rejects its 
contents, which are thrown up in conjunction with more or 
less of a ropy mucus that is secreted by the glands of the 
throat and mouth. The paroxysm then usually abates, and 



564 WHOOPING-COUGH. 

the child, after a few moments, resumes its amusements aird re- 
mains tranquil till a repetition of the tit. The coughing some- 
times lasts for several minutes, during which the child will 
be nearly exhausted, and the vessels of the head and chest 
become so turgid with blood, that a hemorrhage from the 
lungs, nose, or ears, may take place. It is not unusual for in- 
fants to be seen reluctantly leaving the nipple to cough till 
they vomit the milk they have just drawn, and as soon as they 
recover from the fatigue, again return to the breast. AYhen 
the child is reduced, it is not unusual for discharges to occur 
involuntarily from the bowels and bladder at the same time. 
Fever usually attends this cough, in some part of its course. 
Occasionally it begins with the cough; but frequently it is not 
perceived for the tint week or two, and in some cases the dis- 
ease is so light as to excite very little fever. The cough 
commonly increases in violence for live or six weeks; when, 
under favourable circumstances,it gradually declines, and finally 
disappears. Should it commence in autumn, and the child be 
exposed to the vicissitudes of winter, it is general. 
rated, and seldom passes over without some evidence of its de- 
structive power. If the child survive, it will remain extremely 
liable to a constant harassing cough, which often results in 
abscess of the lungs, drops^ of the chest, or rapid consumption. 
General dropsy sometimes occurs in consequence of severe 
whooping-cough. The affection is contagious. It is to be 
managed by a proper attention to clothing, always keeping the 
body, breast, and extremities warm, regulating the diet to pre- 
vent fever, keeping the bowels open by castor oil, rhubarb, 
senna tea, or Epsom salts, giving some expectorant medicine to 
keep the throat moist, and endeavouring to allay the spasmo- 
dic action of the windpipe. For this last purpose, from three 
to thirty drops of antimonial wine, or the same quantity vi the 
compound sirup of squills may be given in from half a 
spoonful to a dessert spoonful of milk of asafeetida every half 
hour or hour, according to the age of the child, or the severity 
of the symptoms. Should the child be of very full habit, and 
have fever, or hemorrhage from the lungs, nose, or ears, it 
will be proper to abstract some blood from the arm, by 
the lancet; or from the temples or back of the neck, by cups 
or leeches. From one ounce to three or four ounces may be 
taken according to circumstances. After this, a plaster of 
Burgundy pitch should be placed on the back, from the lower 
part of the neck to the lower part of the chest, and allowed to 
remain as long as it can be borne. Tf removed before the 
tient has recovered, it should be replaced bv a piece of flannel. 
The front pant of the chest may be rubbed from time to time 
with opodeldoc, or the volatile liniment, whenever there 



mumps. 565 

appears to be much difficulty in the respiration. Probably the 
common custom of rubbing the breast freely with warm goose 
grease is frequently useful. When the child is much reduced 
by the effort of coughing, and often vomits the food it takes, its 
diet should be as nutritious as practicable. Plain animal soups 
may be given in small quantities at a time, if its teeth be not 
yet cut; and if able to masticate, it must be allowed to eat a 
little well cooked meat, to sustain its enfeebled system. Its 
bowels will require strict attention. Costiveness must be cor- 
rected by laxative medicines, or injections which contain asa- 
fcetida. Great care is to be taken of the child during the pe- 
riod of its convalescence, to prevent its exposure to cold and 
damp, as it is extremely susceptible of catarrhal affections, 
which may either run their course rapidly, in a debilitated 
constitution, or result in a chronic cough, or, ultimately in con- 
sumption of the lungs. 

Mumps. This is another affection which is sometimes pro- 
pagated by contagion, though it often springs up spontaneously, 
and is not very easily communicated to others. It generally 
begins with a slight fever, with some stiffness of the jaws, and 
a little swelling of the glands under the ear, on one or both 
sides. At first, the enlarged gland can generally be moved 
about under the skin ; but after the fourth day, it becomes firm 
and tender to the touch. The glands under the mouth often 
become as much swelled as those under the ear; and the skin, 
which commonly retains its natural colour, is sometimes slightly 
reddened. The patient soon experiences great difficulty and 
pain on masticating and swallowing, and is troubled with rest- 
lessness, and nervous irritability, though there is seldom muck 
fever. The swelling usually abates in less than a week from 
the commencement, and with it, all the feverish symptoms 
generally disappear. Suppuration of the gland is uncommon, 
but so strong is the sympathy between these glands and the 
testicles of the male or the mammae of the female, that these 
sometimes become very much swelled, causing great pain in the 
parts, and fever. The brain is sometimes the seat of this 
translated action, and then delirium, stupor, and even death 
may follow. 

When the case is mild, little more attention is necessary 
than to keep the child warm, and give it some mild laxative, 
and warm drinks, with a few drops of the sweet spirits of nitre, 
to favour a gentle perspiration. If the swelling suddenly 
leave the throat and attack the breast or testicles, the parts 
which were originally affected should be covered with a mus- 
tard poultice, rubbed with strong volatile liniment, or have 
a fly-blister applied over them, to excite a return of the in- 
flammation and swelling. In more severe cases the skin should 



506 QUIKSY. 

be kept in a state of perspiration, by nauseating doses of anti- 
monial wine and sweet spirits of nitre. To lessen the swelling, 
which is liable to remain after the pain and fever have abated, 
tbe tumours should be frequently rubbed with the soap lini- 
ment or opodeldoc. 

Inflammation of the Tonsils — Quinsy. The glands which 
project into the upper part of the throat, and back part of the 
mouth, are, in some children, as well as in adults, particularly 
liable to inflammation; and, unfortunately, those who have once 
experienced an attack, are very liable to repetitions of it du- 
ring life. In young children who cannot speak, it is difficult 
to recognise the commencing symptoms of the attack, and the 
attention of the mother or nurse is seldom drawn to the infant 
until it is found unable to swallow. Those who can speak, 
commonly complain of some chilliness, with pain or unea- 
at the back part of the mouth. Shortly afterwards swallow- 
ing becomes very difficult, and upon examination of the j 
the tongue is found covered with a white fur, through which 
the red parts of the papillae project, and the whole back part 
of the mouth has a red or livid hue, while the tonsils are seen 
swelled and prominent. 

The large vessels of the neck and throat throb violently: 
there is much headach, fever, and difficulty of breathing and 
speech; the latter, being shortly reduced to a laborious whis- 
per. It becomes almost impossible to drink liquids, alth 
the patient can generally swallow soft food, such as thick 
gruel, thin mush and similar preparations. 

This swelling commonly increases until matter is formed, 
and after some hours of great pain and horrid sense of suffoca- 
tion, it bursts and discharges matter, to the inexpressible 
lief of the patient. 

The swelled glands, however, are sometimes covered with 
an ash or gray-coloured spot of matter, which has been B 
rated from the subjacent inflamed parts: and suppuration rare- 
ly accompanies this condition of the glands, though the pa- 
tient is not in a less dangerous state on this account. 

The abscess almost always opens into the mouth, though it 
sometimes points on the outside, and then leaves an unplea- 
sant-looking scar in healing. 

This disease is apt to run its course very rapidly, and con- 
sequently requires the most energetic treatment, if we expect 
to prevent suppuration. From repeated attacks of the dis 
the gland is apt to become so large as to prove a source of 
difficulty in swallowing and speaking; especially after a slight 
cold has been contracted. 

If there be fever with a pretty full pulse, the patient should 
be freely bled till the pulse is reduced, and a brisk purgative 



CHOLERA INFANTUM. 56? 

should be given, composed of Epsom salts, senna tea, or cas- 
tor oil. After this the feet should be immersed in warm wa- 
ter, and the patient should take every hour from three to 
twenty drops of antimonial wine, and from five to thirty drops 
of sweet spirits of nitre, according to the age, so as to keep 
up a little sickness at the "stomach without absolute vomiting. 
A few American leeches, (from two to twenty,) should be put 
upon the sides of the throat, or some cups applied to the back 
of the neck. When this has been done without effectual re- 
lief, a blister should be placed on the throat or back of the 
neck, or if the case be mild, bathing with equal parts of spi- 
rits of turpentine and sweet oil, or two parts of hartshorn 
water and one of sweet oil will be necessary. "The common 
remedy of scraped potatoes, saturated with hot vinegar, has 
often done good in mild cases — so does the inhalation of the 
steam from hot water, or vinegar and water, when it becomes 
desirable to hasten suppuration. We are decidedly opposed 
to the use of any kind of gargle in the early part of this dis- 
ease. The throat should be kept as quiet as possible, till suppu- 
ration has taken place, when it may be carefully washed with 
flaxseed and wheat bran tea, with a little vinegar or lemon 
juice. Towards the last, however, the gargle may be some- 
what astringent and composed of oak bark or nut gall tea. 

The Cholera Infantum, or Summer Complaint. This 
disease is almost peculiar to children of large cities, and is most 
frequent in those w T ho reside in small, crowded, and ill-venti- 
lated apartments. It is rarely seen, except between the ages 
of three and twenty-four months, seldom beginning before or 
after dentition. It usually begins with vomiting and purging 
about the same time, though, in some instances, purging may- 
take place a day or two before the stomach is materially dis- 
turbed. The tongue, in most instances, is slightly furred at 
the beginning of the disease; but, after a few days, it becomes 
smooth and polished, or dry and brown. The stools are com- 
monly thick, frothy, and fluid, intermixed with little spots of 
-green bile, though, at other times, they are as transparent as 
water, having only some flakes of mucus floating through 
them. After a short time, no bilious matter is to be seen in 
the discharges. The patient usually becomes immediately 
prostrate: and, if not speedily destroyed, it emaciates very ra- 
pidly. The vomiting and purging are not always constant, 
but sometimes occur in paroxysms, after intervals of a few 
hours; and, in some fortunate cases, after a duration of five or 
six hours, they subside entirely. There is evident pain, or great 
uneasiness in the stomach and bowels, especially in the com- 
mencement. The hands and feet are cold, the skin of 
the body and head is hot and dry, and becomes shrivelled or 



568 CnOLERA INFANTUM. 

wilted. The eyes lose their lustre, the eye-lids but half cover 
them, the nose becomes pointed, and the skin contracted upon 
it, while the lips are thin and shrivelled. In this condition the 
child lies upon the lap, or upon the pillow, apparently ex- 
hausted and indisposed to move, except when impelled to vo- 
mit, or cry for cold water: the only thing which it is willing 
to take; and this is often either thrown up instantly from the 
stomach, or suddenly passed off by the bowels. From this 
st,ate it frequently sinks into stupor and insensibility, and 
often dies in convulsions. If the disease do not thus speedily 
destroy life, the stools assume a dark, offensive, and highly 
irritating character; the mouth becomes sore, covered over 
with white fur or superficial ulcers, — the face bloated, the 
abdomen distended with flatulence, and when the system is 
very greatly reduced, the skin is sometimes studded with 
spots of blood effused beneath the cuticle, or there may be 
some watery blisters, scattered about the chest and other 
parts. 

The treatment of this very fatal disease is so complex and 
difficult, that it cannot be explained to a popular reader, or 
intrusted to such, with safety, under any circumstances what- 
rver. Fortunately, it is rare, except in large cities, where me- 
dical advice is at hand, and yields, or becomes mild, almost 
immediately on a removal to a cool country situation. The 
wealthy should take the general advice of their family pi 
cian. and then fly with the child to the open air of a farm or 
small Tillage. The poor should depend on their doctor; and 
we have but one hint to give them. A well ventilated 
apartment in the upper story of a house, if not too much 
heated by the roof, will give their children a much better 
chance of life, with or without treatment, than the ground 
floor. Let the child remain day and night in such a room. 

We have frequently seen the disease in the country, and 
found it very fatal; but only in residences where uncleanly 
habits, and the miserable construction of residences which 
we have censured in the chapter on Hygiene, have produced 
an artificial hot climate and the foul air proper to an alley, in 
the midst of the free atmosphere of healthful districts! 

For the prevention of this disease, we would earnestly press 
upon those mothers who reside in large or compact towns, 
and in the lanes and alleys where the atlection most prevails; 
to keep their houses clean and well aired ; to wash the whole 
bodies of their children, daily, or more frequently, with clean, 
tepid, or cool water, changing their dress sufficiently olten 
to keep them cleanly clad: to abstain from the use of unripe 
or unwholesome fruit themselves, and by all means, to pre- 
vent their children from eating it. Let their infants be sup- 



CHOLERA INFANTUM. 569 

plied, as far as possible, from their own breasts, and if they 
do not supply sufficient nourishment, let the balance be made 
up with pure cow's milk, either alone or moderately diluted 
with soft water. When any teeth make their appearance, or 
the gums appear swelled, and the child is fretful, let the gums 
be carefully and freely lanced; and if there be any eruption 
on the skin, or behind the ears, let no applications be made 
to them, except for the simple purpose of keeping them clean, 
without suddenly drying them up. If they should heal ra- 
ther suddenly, and the child become restless or feverish, let 
a little blister ointment be rubbed behind the ears, till a dis- 
charge is produced, carefully keeping the blisters open, by 
dressing them with a little basilicon or savin ointment. Let 
the child wear flannel next its skin, and worsted stockings on 
its feet, even during the summer season,; and when it has 
passed beyond its first year, let the diet be regulated strictly 
on the principles laid down under the head of weaning. 



12 



( II VPTER V 



OF ADULT FEMA] 



JJpjiearance of the Menses. — In the early j 
is no very materia] differei condition of the I 

except what 1 mthedii. on; but, in tem- 

perate climates, the system 1 from thirl 

years, suddenly set^ about a very important and well ko 
change. The child leaves oil' the amusements which bo 
joyed in common with boj (fident and retiring in 

her manners, and pr. I 
sex. She may now feel a remarkable fulness and 

about the head, with ;. ual dart 

temples, while, at the same tin. 

about the lower part of the abdomen and thighs, with I 
tude, and pain in the back. If now a lew dr. , 1 co- 

loured fluid escape from the vagina, she obtains immi 
lief and boon forgets her Bufferings until, after the lap* 
weeks, the same sensations return, perhaps with less \iol< 
After a few such periods she becomes, as h^r friends would 
say. •• right" Sometio 1 a later 

age; and, frequently, >uinc months elapsi - first apj 

ance, before there are any symptoms - 
Ion- as the* circums *ind to 1 stent with 

continued health, the alarm usually felt by the friends is alto- 
gether unfounded, and all interference with the 1 : na- 
ture is worse than foolish. Mure generally, however, 1 
the delay has continued lor many months, the health of the 
young girl begins to suffer t and she is found to labour 
under chlon 

Chlorosis or Green Sickness. If the - o alluded to 

in our introductory remarks do not take place at th< 
period, the girl is apt to haw coloured, bloated 

face, bad digestion, and palpitation of the heart under the 
slightest bodily or mental exertion. She becomes languid, 
ble, and often excessively nervous, or so dull and that 



CHLOROSIS OR GREEN SICKNESS, 571 

■she can scarcely be roused to common activity. Her ankles 
will swell towards evening; her sleep may be disturbed; and 
her appetite may become so greatly depraved that she will 
desire the strangest articles for food"; such as dirt, charcoal, 
putrid meats, &c. Her bowels are usually costive; and the 
stools, when they occur, are often clay-coloured, for want of 
sufficient bile. Though usually costive, she may at times have 
some griping pains in the bowels. 

In case medical advice cannot be obtained, we believe that 
the following directions may be observed, with some prospect 
of advantage, by an intelligent friend. When there exist no 
obvious objections to this course, growing out of the peculiar 
situation of the patient, we may commence with the adminis- 
tration of an emetic of twenty-five or thirty grains of pow- 
dered ipecacuanha, in a little molasses or sirup. This should 
be followed up by five grains of calomel, ten of rhubarb, and 
five of aloes, as a purgative. The bowels should be afterwards 
kept in regular action, by one grain of calomel and five of 
aloes, given every second or third night till the tongue is clean, 
and the evacuations become natural or bilious. After this, the 
calomel should be omitted, and a grain of the aloes combined 
with four grains of the carbonate of iron, given in the form of 
pills, three times a day. Light nourishing diet and exercise 
in the open air should be recommended in all cases. The pa- 
tient should use the warm, salt foot-bath, and the flesh brush, 
every night and morning; sleeping on a mattress, or hard bed. 
If subject to acidity of stomach, let her take chamomile tea, and 
the bi-carbonate of soda: a tea-spoonful of the latter in a pint 
of the former, will be an allowance for twenty-four hours. 
Bleeding is generally improper in any stage of this affection. 
If the head become hot and painful, the feet should be im- 
mersed in a warm bath, made gradually hotter by the addition 
of hot water : a bladder of cold water, or ice may be kept to 
the head while the symptoms continue, and a little blood may 
be drawn from the inside of the thighs by leeches. The usual 
mode of administering hot infusion of pennyroyal, rue, &c, 
is not only useless, but often prejudicial, because we are una- 
ble to ascertain the exact moment when the discharge should 
appear. The delay or arrest of the usual evacuation often re- 
sults from other diseases, such as chronic liver complaint, or 
protracted intermittent fever, and it is worse than folly to endea- 
vour to force it forward before the disease is cured, when it 
will generally reappear spontaneously. 

The various nostrums for female diseases, which are recom- 
mended with so much assurance by the manufacturer or vender, 
are dangerous, and should never be employed. Though some 
o( them may have been used originally, with much success, by 



572 SUPPRESSION OF THE MENSES. 

eminent physicians whose names they sometimes bear, they 
have been essentially modified by passing through the hands of 
a succession of druggists, each of whom combines the ingre- 
dients in different proportions, or substitutes one for another, 
tiH they resemble an old ship which still passes under the same 
name, though she has been so often repaired that not a single 
original timber remai; 

Suppression of the Menses. — The woman may have u been 
right," or " regular," for a longer or shorter period, yet c 
to some such cause as jiettin^ her feet wet, or bein:: in other 
respects out of health, the discharge may not recur, though she 
may have the premonitory symptoms in greater degree than 
usual. There may be headach, pain in the bones, and espe- 
cially in the back, with fulness, bearing down, and a distressing 
irritation of the bowels, but no discharge from the uterus. 
Now the conditions of the system under which this occurs, are 
various. The patient may be either in a state of vascular ex- 
citement, or she may have spasm of the uterus. If she have 
fever, headach, a rapid and full pulse, a hot skin, thirst, and 
tenderness over the uterus, her > be treated by bleed- 

ing from the arm till she become I 

salts, confinement to bed, low diet, and ulva, 

or cups to the inner side of the thigh<. When the inflamma- 
tory action is reduced by these means, the will pro- 
bably return and continue, unless interrupted by some new 
cause. 

If the patient be thin and delicate, and of a nervous con- 
stitution, the same causes which excited inflammation i 
the circumstances just described, n -ion the spasmodic 

contraction of the uterine and thin 

sion of the meow a The patient, instead of 
will then be chilly, with co!«l extr and alt: 

will sutler some pain, there will not be any particular tender- 

the uterus. In this condi- 
tion, the patient should be (he warm hip 
bath; warm drink: Mich as barley water, r. 
of catnip, or very weak pennyi : and the pow- 
der, with cample three or 
hours, till the pain a: >'wo drachma of a>ato?tida, dis- 
solved in six ounces of hot water, and used warm as an injec- 
tion, often acts with great promptitude. If it do not give re- 
lief in a short time, half the quantity may be repealed, with 
the addition o( i\tiy drops of laudanum. If now no menstrual 
action take place, we consider the one of obstr 
menstruation. 

Obstructed Maubruation. — By this term we met 
pression of some standing. In this form of the complaint, there 



OBSTRUCTED AND PAINFUL MENSTRUATION". 573 

are generally some symptoms which resemble those of chlo- 
rosis. The appetite fails, or becomes deranged ; the patient is 
often afflicted with headach, dropsical swellings, and many 
other disturbances, which sometimes involve the mind itself, 
causing even incurable insanity. In some women the diges- 
tion alone is affected. If we know that conception and preg- 
nancy are not the cause of the suppression, the remedies re- 
commended under the head of chlorosis, will be proper; but it 
may be added, ^hat the patient who has once menstruated 
freely, is generally capable of bearing the loss of more blood, 
than the chlorotic female. An excellent preparation for the 
purpose of keeping up the regular action of the bowels, and 
exciting a disposition to menstruation, is the following com- 
bination. 

Take, Powdered rhubarb, 1 drachm. 

Powdered aloes, ^ drachm. 

Castile soap, 8 grains. 

Oil of pennyroyal, 2 drops. 

Mix them, and divide the mass into forty pills. Let two 
pills be taken every morning and evening, till they operate; 
then, one or two daily to keep the bowels open. 

For that obstruction which accompanies consumption, two 
grains of aloes, with two grains of the dried sulphate of iron, 
and Venice turpentine enough to make them adhere, may be 
given two or three times a day for some time. 

Of Painful Menstruation. — Some females are regular enough 
as to the period of their monthly " visitations," but are an- 
noyed greatly, at these times, by the pains they experience, in 
the lower part of the abdomen, resembling colic or diarrhoea, 
and obliging them to make frequent efforts to relieve the 
bowels. This distress commonly lasts only for a few hours, 
and when the discharge is established, it passes away: but, in 
other cases, there are severe pains, darting through the loins 
and pubes, attended with an excessive tightness about the 
head and weakness of the knees, for some time previous to 
the discharge. The flow now occurs, not in the thin, fluid 
form which it usually presents, but in flakes or little masses, 
sometimes resembling a false membrane which has lined the 
inside of the uterus. The whole amount of the discharge is 
generally less than when the secretion is healthy, though some- 
times, after the membranous matter is thrown off, the thinner 
discharge is so abundant as to enfeeble the patient very much; 
indeed, she always feels more exhausted after painful menstrua- 
tion, even though the secretion be small. While this state of 
things exists, the woman has but a slender chance of becoming 
a mother. 



574 EXCESSIVE MENSTRUATION, OK FLOODING. 

In Ihc treatment of this distressing affection, two things are 
to be done: First; to relieve the paroxysm. If the patient 
have a flushed face, a hot skin, full active pulse, and tender- 
ness on pressure upon the uterus, she should be bled, and 
purged, and should pass half an hour in the hip bath, the tem- 
perature of which should be raised gradually, from nine! 
one hundred and ten degrees, and then gradually lowered be- 
fore she leaves it. She must abstain from strong food or heat- 
ing drinks. If, however, the woman have a feeble, nervous 
constitution, the above directions will not apply: but in their 
stead, we should order mild laxatives; such as a Seidlitz pow- 
der or two; or a tea-spoonful of sulphur and molasses, or a table- 
spoonful of spiced sirup of rhubarb, combined with a tea- 
spoonful of calcined magnesia. Alter the operation of thi- 
gative, five grains of camphor mav I every two or 

three hours, in a litt!< -imp, until the pain is abated. 

We have also known much good to result from the folk 
prescription : — 

Take, -iateofiron, 4 grains. 

Powdered ipecauanha, £ grain. 

Pn\\ urn, rain. 

To be taken at once, in a little sirup or mi 

This Ikk h fiord I relief in several rases in which 

there was no inflammation. The warm hip bat: melj 

useful to the delicate and nervous female, at the time of pain- 
ful menstruation. In the second pla 

made to prevent the return of the pain, &.C, nt the next men- 
strual peri pon very high authority, the volatile tincture 
ofguaiacum is recommended as the best medicine for 
this object If lh< inflamm 
position, she is to | lonful of this 
morning, noon, and e 
milk, or a little sherry, Ma< 

ten necessary to contii aid it 

sometimes fails alt 

Excessiv M nstrualion, or Flooding females have 

very profuse discharges, regularly and habitually. They ap- 
pear blanched, thin, or bloated, with waxen countenances. 
They may have very little pain, but a copious discharge of clot- 
ted blood at their monthly period. They become nervous, 
and complain of shortness of breath, palpitations, and faint- 
ness, or are completely overcome by the slightest mental or 
physical effort. At first, this hemorrhage obs gulir pe- 

riods; but, after a time, the woman seems to be "always un- 
well:" having a constant dribbling, which wastes her - 



PINAL CESSATION OF THE MENSES. 575 

and at last renders her incapable of exercise. The horizontal 
posture, repose, a regular state of bowels, and a nourishing, 
but mild diet, will be proper in such cases. One-fourth of a 
grain of opium, two grains of sugar of lead, and half a grain 
of ipecacuanha, should be given every two or three hours, till 
the discharge is arrested; but the use of this remedy should 
not be continued long, in the absence of medical advice. An 
injection of fifteen grains of sugar of lead, a tea-spoonful of 
laudanum, and two table-spoonsful of water, mixed, may be 
thrown slowly into the bowels. After the discharge is 
checked, an injection of hve or six ounces of cold water should 
be used twice every day for a long time. It should be passed 
so gradually, that the bowels will not be stimulated to action; 
and it ought to be given in bed. This remedy is inadmissible 
during the regular period for being unwell. As a general to- 
nic, ten drops of elixir of vitriol, one grain of sulphate of 
zinc, and thirty drops of the tincture of cinnamon may be given 
in a gill of weak peppermint water, three times a day. The 
vegetable bitters are less useful than the mineral tonics. When 
the discharge continues obstinate, and there is reason to sus- 
pect the existence of cancer, fungus, or some other organic 
disease, a careful inspection should be made by an experienced 
member of the profession, as soon as such advice can be ob- 
tained. 

Final Cessation of the Menses. About the age of forty- 
five, women, in temperate climates, approach the "time of 
life." The monthly periods then become irregular, the discharge 
sometimes diminishing very much in quantity, or remaining 
absent for several months, and then returning so profusely as 
to prostrate the patient very much. In other cases, the quan- 
tity is so small, and gives so little relief, that the woman is 
subject to giddiness, dimness of vision, vertigo, pain in the head, 
or other distressing sensations. In some instances the change 
takes place without any disturbance. Women, in general, 
look forward to this period with much anxiety; for there is a 
popular belief, not without too much foundation in truth, that 
at, or shortly after this period, diseases of the breast and ute- 
rus exhibit themselves. 

Those who are subject to much pain or inconvenience on 
account of this irregularity, should carefully attend to their 
condition. If they feel much fulness about the head, with 
pain or giddiness, they should reduce the quantity of food, 
and abstain from meat and all other animal substances. They 
should keep their bowels free by frequent and small doses of 
Epsom, Glauber, or Rochelle salts, or cremor tartar and sul- 
phur; and, if not manifestly relieved by this course, they 
should lose six or eight ounces of blood from the arm, occa- 



576 LEUCORRHGEA OR WHITES — PRURITIS VULViE. 

sionally; making the intervals between the bleedings longer 
and longer. Regular, but not violent exercise, in the open air 
is of the highest importance. 

Leucorrhoza, Fluor Jllbus, Whites. Some women are sub- 
ject to a discharge of a fluid, usually light coloured, but occa- 
sionally green or yellow. Sometimes it is thin ; at others, 
thick and adhesive: the quantity varies in different persons, 
and at different times in the same person. In some individu- 
als it gives no uneasiness, while in others it occasions much 
constitutional disturbance, breaking down the health of the 
strongest female by slow degn 

This discharge is a symptom in various affections of the 
uterus and vagina. Great mental emotions, severe labours, 
chronic inflammation or organic disease of the vagina or ute- 
rus, a displacement of the latter organ, or unsuitable instru- 
ments introduced into the vagina to support it, often produce 
irritation and discharge. 

Te relieve this complaint, when there is no organic di.- 
of the uterus, let the patient pay the strictest attention to the 
cleanliness of her person in general, and of the parts whence 
the fluid i If she have pain in the back, quick pulse, 

and headach, with fever, let her lose a few ounces of blood 
from her arm ; let her bowels be purged with Epsom or 
Glauber salts, or magnesia, alone or with rhubarb; krep her 
quiet for several days in the horizontal position, till the pain 
in the head and back, and the fevi lieved: after this, 

she may use a solution of a drachm of alum in six ounces of 
water, cold or warm at option, or half a drachm of sulphate of 
zinc, dissolved in six ounces of rose water — a part of this to 
be thrown into the vagina, by a proper female sj vo or 

three times a day. A tea made of the black oak bark, or a 
weak infusion of nut galls, sometimes answer- 
purpose as an injection: so does weak lead water. All the 
vegetable injections, however, should be avoided as long as 
there is heat in the parts. Cold water alone, several tii. 
day, will be very useful till the inflammation has passed away, 
or has been much reduced. 

Warm clothing should be worn about the waist and lower 
extremities of all women subject to this a flection. Flannel draw- 
ers should always be used in cold weather. We possess much 
more powerful means for arresting the course of obstinate cases, 
than those above described; but we do not feel justified in dis- 
cussing them in a popular treatise. 

Pruritis Vuha\ Etching of Ik* External Gemitml ( _ . — 
delicate internal lining of the external organs of generation, 
sometimes becomes the seat of a mo>t I Qg itching, to 

relieve which, the parts may be so irritated by friction, as to 
become violentlv inflamed. Leeches have been used some- 



FALLING OR PROLAPSUS OF THE UTERUS. 577 

times with benefit; so has the application of cold; as ice water, 
or even lumps of ice introduced into the vagina. When there is 
an eruption like that in the sore mouth of children, injections 
of a strong solution of borax' have been very useful ; thick 
starch water with a solution of sugar of lead, injected into the 
vagina, and retained for an hour or two, have been also of great 
utility in a few cases under our care. This irritation some- 
times arises from disease of the uterus, pregnancy, the presence 
of a stone in the bladder, or worms in the bowels. The original 
affection must first be attended to in these cases, as elsewhere 
directed. 

Falling or Prolapsus of the Uterus. — The uterus is so situated 
in the human female as to be subject to a variety of displace- 
ments, some of which excite so much influence on the health 
of the individuals who have incurred such accidents, that a few 
observations on the subject appear peculiarly necessary in a 
work like the present. 

The most common displacement is, perhaps, the descent , 
falling, or prolapsus of the womb. In this case the uterus be- 
comes too much depressed towards the bottom of the vagina ; 
so that its mouth lies upon the lower surface of the passage, 
producing a slight bearing down, sensation in the part, and 
some dull or acute pain in the back, especially when the pa- 
tient is long upon her feet. This pain disappears soon after 
lying down, and the patient rises in the morning apparently 
well. Soon after the business of the day commences, her pain 
and distress return. A discharge of whites now presents itself, 
if, indeed, it have not preceded, or caused the accident. The 
inconvenience goes on increasing, under common exercise, till 
the patient becomes feeble, nervous and dyspeptic, the local 
suffering may now become worse, or it may be lost in the im- 
pression of pains low down on the left side of the abdomen and 
under the short rib, dragging and distressing soreness about the 
loins, tenderness of the lumbar vertebra, dragging and colic, pains 
about the umbilicus, and, perhaps, costiveness and painful or 
difficult urination. But a sudden fall, lifting a heavy weight, 
light lacing in the ball room, or a walk or ride over a rough 
road, may produce sudden displacement. The woman is in- 
stantly seized with pain at the bottom of the stomach, in one of 
the hips, or all round the back ; with a strong bearing down, 
an inclination to pass her water every minute, or an im- 
pulse to evacuate her bowels* She may become faint, or have 
a paroxysm of hysterics. Under these circumstances, it often 
happens that the uterus has been suddenly depressed almost to the 
the orifice of the vagina, pressing upon the rectum and the neck 
of the bladder, so much as to cause the inclination to evacuate 
them, 

73 



578 FALLING OR PROLAPSUS OF THE UTERUS. 

If this state of things be long neglected, the bladder may al- 
most assume the position of the uterus, and the latter may slip 
entirely out of the body. The whole organ is now suspended 
between the thighs of the wretched patient, and her sufferings 
commonly exhaust her physical and mental energies. Yet 
such is the vigour of constitution in some women, that they 
move about, and attend to laborious business without evincing, 
to a mere spectator, the existence of any special disorder. This 
sudden affection is to be treated by rest on the back in bed, 
with the hips raised, when the displacement is in the Grst de- 
gree, and of recent occurrence. The same remedies are pro- 
per when the disorder has reached the second stage, (the 
mouth of the womb presenting at the external orifice,) except 
that it is then often necessary lo r< store the womb to its natu- 
ral situation by pressing it upward and backward by a i. 
or two passed into the vagina. 1 1 there be any pain in this opera- 
tion, the vagina should be well crashed by injections of thick 
flaxseed or slippery elm bark t day or two before the 

astringent washes 11 

When the womb bai ly out of th 

which is always drawn down and inverted, the parts some- 
times become suddenly so swelled that it would be impossible, 
as well as improper, to return them at once. The inflamma- 
tion is to I"' reduced by leeches, ice water, or warm fomei 
poultices of bread and milk, or hops and flaxseed, continually 
applied until the swelling and pain subside: then, with the 
hand well oiled, and the patient's hips well elevated upon a 
cushion or pillow at the edge of the bed, tl m is to be 

(1 carefully within the vagina, and restored to its natural 
situation. The bowels and bladder must be regularly evacu 
but the patient should not be allowed to 

and should even then assume the upright position very ^radu- 
allv and cautiously, after ha-. 1 anodyne and at in- 

jections from the first. The injection- 1 for the 

support of the vagina and uterus should be made of the fol- 
lowing ingredii 

Take one drachm of alum and dissolve it in half a pint of 
clear water: or, half an ounce of the inner bark of the black 
oak, with three gills of water; boil down to a pint and 
strain. Two ounces of either of these preparations should 
be injected into the vagina, by means of a . the 

extremity of which should he perforated with a number of 
orifices, to conrey the fluid to different points of the surface 
on which it is to act. The syringe invented by Dr. I Phi- 

ladelphia, we consider the best. This operation should be re- 
peated twice a day. for a week or more; the syringe being 
always well lubricated with lard or oil, that it may be intro- 
duced without difficulty or pain. 



ANTIVERSION OF THE WOMB, &C. 579 

From thirty drops to a tea-spoonful of laudanum may be 
used in the injection, when there is much sensibility; and this 
may be repeated everyday or two till the sensibility disap- 
pears. The patient may now be allowed to move about her 
room ; and if she discover no return of the symptoms, she may 
gradually resume her domestic duties, avoiding for a long 
time any efforts at lifting, long walks, &c. 

If there be frequent relapses, or if the case be chronic, she 
should wear a pessary, which should be accurately adjusted; 
but this and all other instrumental means of support, should 
be directed by a professional gentleman who should be made 
acquainted with the case. 

Most of the pessaries commonly on sale, (none of which 
are adapted to the whole round of cases,) and all the " abdomi- 
nal supporters" known to us, are injurious instruments. 

Retroversion, or Falling of the Womb backwards. The 
uterus is also liable to falling backwards, so that its body, or 
rather its very top part, presses upon the bowel behind, while 
the mouth, instead of over-hanging the lower part of the va- 
gina, is drawn upward so as to press against the neck of the 
bladder, which, soon becoming distended, very much increases 
the difficulty, and renders the escape of urine, as well as that 
of the contents of the bowels, almost impossible, the distress 
from bearing down is very great, and immediate relief is ne- 
cessary. The parts should be examined by the finger passed 
into the vagina, when a tumour will be felt obstructing the 
passage, making it very short, and pressing upon the bowels. 
No neck or mouth of the uterus can be found, unless it can 
be felt, very high upwards, just behind the arch of the pubes. 
The management of this affection is purely surgical, and must 
be confided solely to experienced men. 

The bowels and bladder should be kept open by glisters, and 
the patient ordered to remain in bed till she can be seen by a 
physician or surgeon. If a practised female accoucheur be 
present, she should always use the catheter, immediately, to as- 
certain the nature of the case. 

Antiversion of the Womb. The unimpregnated uterus is also 
liable to fall forwards; but this extremely rare difficulty is in- 
telligible to surgeons alone. 

Of Polypus and Cancer of the Womb. Under the head of 
Flooding, we alluded to the hemorrhage arising from polypus 
and cancer. We come now to make a few observations in re- 
lation to each of these affections, merely to point them out to 
those who are liable to suffer from them ; for we are fully per- 
suaded that these cases should never be left to run their course 
without claiming the attentive consideration of the surgeon-ac- 
coucheur. 



580 POLYPUS OF THE UTERUS — CANCER OF THE UTEP 

Polypus of the Uterus. When the woman has been wasting 
away for some time, under a more or less copious discharge of 
blood, and the remedies recommended under the head of flood- 
ing have been faithfully, but unsuccessfully u<ed; — when, during 
this time, the has remained free from burning and pain in the 
part, but has merely complained of a sense of weight in the 
womb, — there is great reason to suppose that she has a poly- 
pous excrescence growing there. This polypus may spring from 
any part of the inner surface of the womb : When it arises from 
the body, or considerably within the neck of the organ, it can- 
not be detected until it distends the mouth sufficiently to admit 
the point of the finger; or, until the polypus itself descends into 
the vagina. In the latter case, it may be found smooth and 
round, from the size of a walnut to that of a child's head As 
it grows, (which it sometini' apidly.) it causes much 

unca- lit and by distending the parts. The dis- 

ease beiog i advice should be 

Jit immediately. 

Cancer of the I Some women of active habits and 

devotion to their occupations may, at times, have their at- 
tention called to a sudden pain \ ots through the bottom 
of the abdomen, and • after 
it a dull at- hi i ompanied by more 
or lea fa fluid, which bsocnet and thin, but 
soon becomes thi< . pcrhap 1 with biood, 
and very offensive. This pain is gradually rendered more se- 
vere and aim "it, and an exhausting hemorr! 
in at times, perhaps continuing until checked bj In 
other ind more delicate temperament, 
a burning heat, followed by barge of mat- 
ter mixed wil - of blood. At their month! 
riods, or even in the intervals, they may have a copious irrup- 
tion of blood which blanches their skins, and gives them a 
\\a\en, vet bloated counten ihen too much 
son to fear th f the ute- 
rus; — cither true l d and equally 
feet ion. 

The only domestic treatment which c y be adminis- 

tered, in this will he merely palliative. Clean: 

fresh air, plain nutritious diet, regulation of the bowels, and 
tranquillity o\ mind, are all that can be recommended in a work 
like this. The woman who has the misfortune to I with 

this affection must resolutely determine to retire early from the 
active duties of life, and be content I n from in< 

which would heat the system, ex :ite h< r I increase 

the circulation of block! . Bland, soothing nourishment, and lo- 
cal applications, are all that can be administered until she 



POLYPUS OF THE UTERUS. 581 

have judicious and experienced medical assistance. Her bow- 
els should be kept open by the mildest laxatives that will effect 
the object, the fetid and erosive discharges should be washed 
away by injections of flaxseed tea, Castile soap-suds, or a solution 
of chloride of lime or soda, with a little hop or chamomile tea. 
When the hemorrhage becomes very profuse, the vagina should 
be plugged up with a fine sponge, or a strip of fine rag, imbued 
with strong alum water. 

Formidable as the last two diseases are, they are not always 
beyond the reach of surgery. 



APPENDIX. 



FORMULARY. 

List of Preparations mentioned, but without details, in the body of the work, and 
which may be prepared at the residence of the patient. Those marked with 
an • are not prepared exactly in accordance with the custom of Pharma- 
ceutists, but are either simplified to accommodate the domestic adviser, old 
hospital prescriptions which have never been published, or modifications 
employed by the author. 

i 

Mum — Burnt or Dry. 

Take any quantity of alum, and heat it on a clean shovel, 
over a fire. It will melt in its own water of crystallization, 
and boil for some time. When it becomes perfectly dry, let 
it cool, and then reduce it to a fine powder in a mortar. 

Jisofoztida Mixture. 

Jisafodida Tea — Milk of Jlsafcetida. 

Take of, Asafoetida, 2 drachms. 

Pure water, boiling, \ pint. 

Pour the water gradually upon the gum in a mortar, rub- 
bing the mixture from time to time, and decanting the first 
portions of the mixture, before each addition of the hot wa- 
ter. The result is a milky fluid. It will not bear keeping 
many days. It is a powerful antispasmodic, and a stimulating 
expectorant. Dose, for an adult, a table-spoonful. 

* Blister Ointment. 

Take of, . Simple Cerate, any required quantity. 

Warm it, and mix it with powdered Spanish flies, by rub- 
bing in the powder with a knife or spatula, until the mixture 



584 APPENDIX. 

shows a disposition to crumble. The back of a plate or 
dish will present a good surface for making the mixture. 
When spread on leather or muslin for use, it is well to warm 
the surface of the plaster, and then dust it with the dry pow- 
der of the fly, allowing all that adheres to remain. 

* Brown Mixture. 
Take of, Extract of liquorice, 3 drachms. 

Dissolve it in five ounces of boiling water, by rubbing it ir> 
a mortar, and adding the water gradually. 

Then add, Powdered gum Arabic, 2 drachms. 

Let the mixture cool, and add — 

Antimonial wine. Iiachms. 

Acetic tincture of opium, I drachm. 

This is a valuable expectorant. The same quantity of lau- 
danum* or three times the quantity of paregoric elixir, may 
be substituted for the acetic tincture of opium, if this be not 
at hand. Dose, for an adult, a table-spoonful every two or 
three hours. 

Camphor Mixture. 

Camphor, 1 drachm. 

Alcohol, ii ops. 

Calcined magne- £ drachm. 

Powder the camphor with the alcohol in a mortar, next add 
the magnesia, and rub the ingredients well together, then add, 
gradually, one pint of pure water, continuing the triturations. 
When complete, filter the mixture through paper. If alcohol 
cannot be procured, proof spirits will auswer tolerably well, 
in four times the quantity. 

This is an anodyne, antispasmodic, and diffusible stimulant. 
Dose, for an adult, one or two table-spoonsful every hour or 
two. 

mphor Julap. 

Take of, Camphor, 1 drachm. 

Mcoliol. 10 d: 



APPENDIX. 585 

Triturate these in a mortar, then add — 

White sugar, 2 drachms. 

Powdered gum Arabic, 2 drachms. 

Triturate again, thoroughly, and add — 

Boiling water, 6 ounces. 

Boiling milk may be substituted, to advantage, for the wa- 
ter, in this preparation. Dose, for an adult, a table-spoonful 
every hour or two. 

* Cerate of Impure Carbonate of Zinc. 

Turner's Cerate. 

i 

Take of, Carbonate of zinc, 2 drachms. 

Simple cerate, ] ounce. 

Rub the carbonate into a fine powder on the back of a plate 
with the knife or spatula, then add it by degrees to the sim- 
ple cerate, previously warmed, and rubbed on the back of 
another plate. Mix them thoroughly by rubbing. If the 
simple cerate be quite hard when cold, substitute a little lard 
for a portion of the cerate — and rub it well in before adding 
the zinc. 

These directions differ a little, but not essentially, from the 
more troublesome officinal orders for preparing the article. 

Cerate — Simple. 

Take of, White wax, 1 pound. 

Lard, 4 pounds. 

Melt them with a gentle heat, and stir till cool. 

Yellow wax will answer all domestic purposes equally well. 

For other cerates, see Ointment. 

* Chalk Mixture. 

Take of, Prepared chalk, 2 drachms. 

Powdered gum Arabic, 2 drachms. 

Tincture of opium, (laudanum,) 1 drachm. 

Pure water, 6 ounces. 

Mix in a mortar. 

An astringent and antacid. Dose, for an adult, a table- 
spoonful every three, four, or six hours. The common chalk 

74 



586 APPENDIX. 

mixture of the Dispensatories, is prepared without the lauda- 
num. 

* Chalk Mixture with Kino. 

Take of, Chalk mixture, 6 ounces. 

Add, Tincture of kino, 2 drachms. 

This is powerfully astringent. Dose, as in the last pre- 
scription. By doubling the quantity of the laudanum and 
tincture of kino, we form the prescription for the premonito- 
ry stage of Asiatic cholera, mentioned at page 453. 

* Decoction of Cantharides. 

Take of, Powdered cantharides, | an ounce. 

Spirits of turpentine, ] gill. 

Boil them together, for half an hour, in an earthen vessel 
or an oil flask, on the top of a hot stove, covered with house- 
sand. 

This is a powerful rubefacient. It is exceedingly inflam- 
mable, and must never be brought near the fire. 

Decoction of Oak Bark. 

Take of, Oak bark, 1 ounce. 

Water, 1 quart. 

Boil them down to a pint, cool, and decant 

Decoction of I 

Take of, Bear-berry leaves (arbutus uva ursi,) 1 ounce. 
Boiling water, 1 pint. 

Boil for ten minutes, in an earthen vessel, and strain. 
Dose, for an adult, a wine-glassful every three or four hours. 

Decoction of Quince Seed, 

Take of, Quince seeds, 2 drachms. 

Boiling water, 1 pint. 

Boil over a slow fire, for ten minutes, and strain. 

This is a simple mucilage. 

For other decoctions and hot infusions — see Infusions. 



APPENDIX. 587 

Dover's Powder. 

Take of, Powdered opium, 15 grains. 

Powdered ipecacuanha, 15 grains. 
Sulphate of potassa, 2 drachms. 

Mix them well, in a mortar, and divide any quantity of this 
mixture into powders containing ten grains each. 

We prefer, for convenience, and for some other reasons 
the following: — 

* Substitute for Dover's Powder. 

Take of, Nitrate of potassa, (salt petre,) 2 drachms. 
Opium in powder, 12 grains. 

Ipecacuanha in powder, 12 grains. 

Mix them very thoroughly, in a mortar, and divide the 
mixture into twelve powders. 

Effervescing Draught. 

Take of, Sub-carbonate of potassa, (pearl ash.) 3 drachms. 
Water, . 6 ounces. 

Mix them in a six ounce vial. Then — 

Take of, Fresh lemon juice, 3 ounces. 

Water, 3 ounces. 

Mix them in another six ounce vial. 

Mix two table-spoonsful of the latter mixture, with one of the 
former, in a small cup, and let it be taken while foaming. 

* Infusion of Bone-set. 
Bone-set Tea. 

Take of, The dried leaves of Bone-set, 

(Eupatorium perfoliatum,) f an ounce. 
Boiling water, 1 pint. 

Let the tea draw over the stove or before the fire in a co- 
vered earthen vessel, for twenty minutes. The modes of admi- 
nistering this highly valuable infusion are various. In severe 
colds, when the object is a powerful perspiration, it should be 
taken as hot as possible, and always when the patient is co- 
vered warm in bed. An adult should take half the above quan- 
tity as rapidly as its heat will permit— the remainder, again 



588 APPENDIX. 

heated, may be taken in two doses, at intervals of half an hour. 
When used as a tonic, it should be taken quite cold, in doses of 
a wine-glassful every two hours. When taken moderately 
warm, it often produces vomiting, and if made of twice the 
above named strength, it constitutes an emetic, popular in coun- 
try places, but disagreeable in its operation. 

Infusion of Cascarilla. 

Take of, Cascarilla bruised, 1 ounce. 

Boiling water, 1 pint. 

Let the mixture digest in an earthen vessel over a warm 
stove, or before the fire, for two hours without boiling. Dose 
for an adult, a wine-glassful every three, four, or six hours. It 
is a tonic. 

Infusion of Chamomile. 

Chamomile Tta. 

Take of, Chamomile flowers, \ an ounce. 

Boiling water, 1 pint 

Let it draw before the fire for ten minutes, and strain. This 
is taken generally cold, as a tonic — Dose, a wine-glassful, fre- 
quently. 

Infusion of Columbo. 

Take of, Columbo root, in slices, | an ounce. 

Boiling water, 1 pint. 

Let it simmer for half an hour, in ;in earthen or iron vessel. 
This is a powerful tonic. It will not bear being kept beyond 
two or three days. Dose, a wine-glassful or less every six 
hours. 

* Infusion of Flaxseed. 

Take of, Flaxseed, I tea-cupful. 

Boiling water, 1 quart. 

Tie the flaxseed in a clean piece of linen ; then pour upon it 
the boiling water, and let them stand over the stove or near the 
fire, for an hour or two; taking care that the temperature of 
the fluid be not permitted to reach quite to the boiling point. 
Decant the liquor, and if it be designed for a drink, let it be 
sweetened, to the taste of the patient, with brown sugar. If 
desired, and admissible, a little lemon juice may be added. 

Prepared in the usual way, by boiling, the flaxseed tea be- 
comes extremely injurious to "the tone of the stomach: but when 



APPENDIX. 589 

made in accordance with the directions just given, it is a de- 
lightful mucilage. This prescription differs from the officinal 
preparation, principally in the substitution of brown sugar for 
liquorice, which is a decided improvement. 

* Infusion of Galls.' 

Take of, Bruised galls, 2 drachms. 

Boiling water, £ a pint. 

Let the mixture stand covered in an earthen vessel, and in 
a warm place for two hours. Then strain it, and add, 

Rose, Cinnamon, or Mint water, 2 ounces. 

This is a strong astringent. Dose, for an adult, a table-spoon- 
ful every two hours. Without the aromatic, it is often useful 
as an external application. 

* Infusion of Horse-mint. 

Take of, The dried leaves of Horse-mint, 

(monarda punctata,) h, an ounce. 

Boiling water, 1 pint. 

Let the mixture stand covered in an earthen vessel, and in a 
warm place for twenty minutes. Then- cool and decant it. 
This is a valuable article in protracted vomiting, when not 
caused by organic disease or high fever. It is very useful in 
sea-sickness. Dose, a wine-glassful taken frequently. It is an 
excellent substitute for liquor, when given to the intemperate 
who attempt reformation. It should be taken cold. 

Infusion of Quassia. 

Take of, Quassia rasped, 2 drachms. 

Water, cold, 1 pint. 

Let the mixture digest twelve hours, and strain. This is an 
excellent bitter tonic. Dose for an adult, a wine-glassful three 
times a day. 

Infusion of Senna. 

Senna Tea. 

Take of, Senna, I an ounce. 

Coriander seed, bruised, \ a drachm. 

Boiling water, \ a pint. 

Let them stand for an hour in a warm place, then strain, 



590 APPENDIX. 

and let the mixture cool. Half this quantity is a dose for an 
adult, but it may be repeated in four or six hours, if necessary. 
It is a powerful purgative, and prone to produce some griping. 

Some other infusions are mentioned in the body of this work, 
but when express directions for their preparation are not given, 
it is presumed that the general knowledge of these simple re- 
medies renders unnecessary any formal prescription. 

Lime Water. 
For domestic use lime water is best prepared thus — 
Take of, Unslacked lime, about h a pound. 

Very pure water," 2 or 3 quarts. 

Place the lime in a wide-mouthed earthen vessel, and pou r 
the water upon it. Let the mixture stand a few minutes ; then 
stir it well and decant it into clean porter bottles.before the lime 
subsides. Cork the bottles tightly, and, if designed for long keep- 
ing, seal them. When used, the lime water is to be poured off 
without agitation, and only that which is perfectly clear should 
be used. The slightest access of the air rapidly spoils lime 
water; and even a cork will not prevent its being changed in a 
few months, unless covered by sealing. It can be readily pre- 
pared extemporaneously; but in countries where the spring or 
river water is not pure, distilled water or rain water collected 
directly in a wide-mouthed, clean vessel will be required. 

Neutral Mixture. 
Saline Draught. 

This can be more elegantly and correctly prepared by the 
apothecary; but in places where such aid cannot be had, the 
following method will answer every purpose. 

Take of, Fresh lemon juice, 2 ounces. 

Sub-carbonate of potassa, (pearl-ash) 1 drachm. 
Pure water, 4 ounces. 

Put the lemon juice into an eight-ounce vial, and dissolve 
the potash in another vessel containing about a gill of pure 
water. Drop the solution of potash into the lemon juice, at 
first pretty rapidly, then slowly; shaking the vial occasionally, 
until the effervescence nearly ceases. Then add more potash, 
drop by drop, tasting the mixture from time to time, until no 
acid taste is perceived, and the last drops produce no very per- 
ceptible effervescence. Be very careful not to add too much 
potash, for it is better to err a little on the other hand. The 
mixture completed, add a little loaf sugar, and let the vial stand 
open for an hour, before corking it. 






APPENDIX. 591 

This is a delightful diaphoretic in long continued fevers with 
irritability of stomach. In its preparation, mint water is some- 
times substituted for pure water. Dose, a table-spoonful every 
hour. 

Nitro- Muriatic Acid Bath. 

Take of, Nitric acid, by measure, 2 ounces. 

Muriatic acid, by measure, 4 ounces. 

Water, in a narrow, deep bucket, 8 gallons. 

Mix them, and use as a bath for the feet and legs twice or 
three times a week. When employed in disease of the liver, it 
is well to bathe the surface over the organ with the same mix- 
ture, by means of a sponge. The mixture may be kept in a 
cool, dark place, and may be used repeatedly without renewal, 
for two weeks. 

We have added two gallons more water than is directed in 
the U. S. Dispensatory, having found this strength sufficient. 

Ointment of Basilicon. 

Take of, Good resin, 5 parts. 

Lard, 8 parts. 

Yellow wax, 2 parts. 

Melt them together, or stir the mixture till cool. 

* Ointment of Cicuta. 

Take of, Extract of cicuta, 2 drachms. 

Simple cerate, I an ounce. 

Rub them well together on the back, of a plate, with a knife 
or spatula. 

* Ointment of Celandine. 

Take of, The expressed juice of fresh celandine, 1 ounce. 

Lard, \ an ounce. 

Melt them together, and evaporate the watery parts, stirring 
the mixture frequently. 

Kentish Ointment. 

Take of, Basilicon ointment, 4 ounces. 

Spirits of turpentine, \ an ounce. 

Rub them well together. 



592 APPENDIX. 



Ointment of Red Precipitate. 

' Take of, Red oxide of mercury, (red preci- 
pitate,) finely powdered, 1 drachm. 
Simple cerate, 1 ounce. 

Warm the cerate, then add the precipitate, gradually rubbing 
it in, thoroughly and evenly, with a knife or spatula. 

Ointment of Savine. 

Take of, Basilicon ointment, 1 ounce. 

Savine, finely powdered, 1 drachm. 

Soften the ointment by heat; then add, the savine, slowly, and 
mix the articles, thoroughly and evenly, with a knife or spatula. 

* Ointment of Stramonium. 

Ointment of Thorn Apple, or Jamestown Weed. 

Take of, Extract of stramonium, 1 drachm. 

Simple cerate, \ an ounce. 

Lard, Irachms. 

First, rub the cerate and the lard together ; then add the ex- 
tract, and make a smooth mixture of the same colour through- 
out. 

This is a substitute for the officinal preparation, which, be- 
ing made of the fresh leaves of the plant, can be prepared only 
at one season of the year. 

Tar Ointment. 

Take of, Tar, 1 ounce. 

Suet, or simple cerate, 1 ounce. 

Melt the suet or cerate with a gentle heat, and stir the mix- 
ture till cool. 

* Ointment of Jflxitc Precipitate. 

Take of, Ammoniated mercury, (white pre- 
cipitate,) 1 drachm. 
Simple cerate, 1 ounce. 

Soften the cerate, and thoroughly rub in the white precipi- 
tate. 



APPENDIX. - 59-3 



Camphorated Ointment of White Precipitate. 

Take of, Simple cerate, 1 ounce. 

Powdered camphor, 1 drachm. 

Muriate of ammonia, 2 drachms. 

White precipitate of mercury, 2 drachms. 

Melt the cerate in an earthen vessel, then add the other in- 
gredients, and stir till cold. Rub the cold cerate on the back 
of a plate, with a knife or a spatula, until the mixture is per- 
fectly made. 

This ointment acts powerfully on the skin, giving rise to a 
cutaneous eruption. lis application must not be carried too 
far, and when used by women and children it may be reduced 
in strength one half, by adding simple cerate. 

The citrine and Goulard's ointments, several times prescribed 
in the body of this work, cannot be well prepared at the Fesi- 
dence of the patient, but must be procured from the apothe- 
cary. The lard used for ointments must be perfectly free from 
salt. 

Charcoal Poultice. 

Take a sufficient quantity of fresh charcoal, (that made by 
extinguishing live coals with dry sand being best) reduce it to 
a fine powder, and mix it with the flaxseed poultice, or with, 
simple Indian mush. 

. Flaxseed Poultice. 

Boil flaxseed meal, in just sufficient water to make a poul- 
tice of proper consistence. 

Fermenting Poultice. 

Yeast Poultice. 

Take of, Flour, I a pound. 

Yeast, 1 gill. 

Mix, and set the mixture in a warm place, to rise. When 
it begins to rise, it is ready for use% 

* Cicuta Poultice. 

Take of, Dried leaves of cicuta, (conium maculatum,) 1 part. 
Crumbs of stale bread, 1 part. 

75 



5£U APPENDIX. 

Boil these in milk mixed with pne-third its bulk of water, 
using just enough to make the mixture, after boiling, of a 
suitable consistence for a poultice. 

We greatly prefer this mode of preparation, to that directed 
in the systematic works. 

Carrot Poultice. 

Boil the sliced roots of the carrot in water, until soft enough 
for a poultice. 

The chamomile, hop, and other poultices, mentioned in this 
work, are all prepared on the same principle with the carrot 
poultice. The hop is sometimes stewed in vinegar and wa- 
ter, when intended for an external application to sound skin. 
The hop pillow is prepared in this way. The bread and 
milk poultice is too well known to need description. 

Solution of the Pith of Sassafras. 

Put four or six inches of the pith from the thicker stems of 
sassafras, or a proportionate quantity from the lesser branches, 
into a six-ounce vial, containing a gill of pure, fresh, cold 
water. 

Cork the vial, and agitate it frequently, for ten minutes. 
The solution is then ready for use as an application to the 
eye. If intended for an injection, prepare a larger quantity, 
let it stand in a warm place for two hours: then again agitate 
it, throw the solution, with the pith, into a piece of linen, over 
a suitable vessel, and express the mucilage by twisting the 
cloth. 

In the first preparation, the pith will bear to have the water 
several times replenished before the mucilage become- 
hausted. 

* Spice- Plaster. 

Take of, Powdered cloves, 1 tea-spoonful. 

Ground cinnamon, 1 tea-spoonful. 

Ground alspice, 1 tea-spoonful. 
Ground black pepper, l tea-spoonful. 

Flour, 5 or 4 tea- spoonsful. 

Mix them into a paste with vinegar — and spread them upon 
muslin. 

If powerful local stimulation be required, Cayenne may be 
substituted for black pepper. The exact relative quantity of 



APPENDIX. 505 

the several spices is not important; but no more flour than is 
necessary to unite them should be used. The cloves and 
pepper are more important than the other aromatic ingre- 
dients, and if either of the latter be omitted, their place should 
be supplied by an additional amount of cloves. 

Spirit of Minder er us. 

Solution of Acetate of Ammonia. 

Take of, Good pure vinegar, 6 ounces. 

Muriate of ammonia, (sal ammoniac,) 
a sufficient quantity. 

Drop the powder very slowly into the vinegar, in an open 
vessel, and continue adding, until the effervescence becomes 
scarcely perceptible. 

This is an excellent diaphoretic in fevers. Care must be 
taken to stop adding the powder before the effervescence has 
entirely ceased; for the decomposition of the salt goes on slow- 
ly toward the conclusion of the process, and it is better that 
the acid in the mixture should be in very slight excess. If 
the solution be kept in a vial, it should be left open for a few 
hours before corking. Dose, for an adult, a table-spoonful or 
two, taken every two or three hours. 

Spirit of Camphor. 

Camphor is dissolved without limit, in alcohol. A good 
proportion for domestic use is an ounce of camphor to a pint 
of alcohol. A few drops of alcohol in a mortar are necessary 
to enable us to powder camphor, when the powder is wanting 
for pills or ointments. 

Terebinthinic Mixture. 
Turpentine Mixture. 
Take of, Spirit of turpentine, 1 drachm. 

Laudanum, , 1 drachm. 

Loaf sugar, 2 drachms. 

The whites of two eggs, 
Pure water, 6 ounces. 

Let the white of egg be placed in a six ounce vial. Then 
pour over it, the spirit of turpentine, the laudanum and a lit- 
tle water. Shake the vial well. Dissolve the sugar in a lit- 
tle water, add it to the mixture and again shake the vial. 
Then fill the vial wkh water, by little and little, — agitating it 
at each addition. Dose, for an adult, one or two table-spoon- 



596 APPENDIX. 

fuls every three hours in cases of collapse. If the mixture be 
designed for a purgative, the turpentine may be doubled in 
quantity, and the laudanum must be omitted. 

Volatile Liniment. 

Take of, Spirit of hartshorn, [aqua ammonias,) 

by measure. 1 part. 

Sweet oil, by measure, 4 or 6 parts. 

Shake them together in a vial. 

The weaker preparation is the more eiegant; but the 
stronger may be employed, when powerful local stimulation is 
desired. 



LIS T 



MI- OF THE PRINCIPAL DRUGS, fi nTIONED IN 

THIS 

As many of those for whose use the present work is writ- 
ten, are placed beyond the reach of pharmaceutical assistance, 
and are very properly in the habit of keeping medicine chests 
for the use of their families or establishments; it is deemed 
advisable to add a list oi' a few of the drugs and implements, 
mentioned in the work, which arc r occasional us 

families. The physician, when called upon an cmerg 
will be glad to find these articles accessible, and all neci - 
additions to the- list may be 8 >usly made by hit 

vice; for they will then be lapted to the peculiar rou- 

tine of practice to which he may have become attached. It. 
is thought useless to add an estimate of quantities, whether 
relative or absolute; for these must be determined by the 
number of persons to be supplied, the location of the family, 
and other circumstances. The advice of an experienced and 
honest dealer will supply the absence of any directions from 
us, on this subject. 

LIST OF DRU( 

Acetate of lead, (Sugar of 1 

Acetic tincture of opium, (Hartsfwr: 

Alcohol. 



APPENDIX. 597 

Aloes. 
Alum. 
Alspice. 

Antimonial wine. 
Armenian Bole. 

Bone-set tea — the herb, (Eupatorium perfoliatum.) 

Borax. 

Burgundy pitch. 

Calomel. 
Camphor. 
Cantharides, (Spanish flies.) 

Tincture of, 
Carbonate of iron. 

of lime, {Prepared chalk?} 

of potassa. 

of zinc, (Lapis caliminaris) 
Carolina pink-root, (Spigelia marilandica.) 
Cascarilla bark. 
Castor oil. 

Caustic potassa, (Vegetable caustic.) 
Chamomile flowers. 
Chloride of soda, 
of lime. 
Cicuta leaves, (Conium maculatum.) 
Chinchona, (Peruvian bark.) 
Cinnamon. 

Tincture of, 

Water. 
Citrine ointment. 
Cloves. 
Columbo root. 

powdered 
Coriander seed. 
Coxe's hive sirup. 
Croton oil. 

Elixir of vitriol, (Aromatic sulphuric acid.) 
Ergot, (Spurred rye,) powdered. 
Extract of cicuta, (Conium maculatum.) 

of dandelion, (Leontodon taraxacum.) 

of liquorice. 

of stramonium. 

Flaxseed. 

Galls powdered. 
Gentian root. 

powdered. 
Goulard's cerate, (Cerate of sub -acetate of lead) 
Gum ammoniac. 
Arabic. 

powdered. 



598 APPENDIX. 

Gum asafcetida. 
Gum guaiacum. 

powder of, 
volatile tincture of, 
Gum kino. 

tincture of, 

Hoffman's anodyne. 

Horse mint — the herb, (Monarda punctata.) 

Huxham's tincture of bark. 

Ipecacuanha — powdered. 
India rubber in sheets or cloth. 

Jalap. 
Juniper oil. 

Lavender compound. 

Laudanum, {Tincture of opium.) 

Magnesia calcined. 

Meadow saffron, (Colchium autumnale,) 

The tincture of the leaves or that of the root. 
Mercurial ointment. 

plaster. 
Mercury, red precipitate of, 

white precipitate of, 
Muriate of ammonia, (Sal ammoniac.) 
of iron, tincture of, 

Nitric acid. 

Nitrate of silver, (Lunar caustic.) 

of potassa, (Saltpetre.) 
Oak bark. 
Opium. 

powdered. 
Opodeldoc. 

Paregoric elixir. 

Pennyroyal — the herb, (Hcdeoma pulegioides.) 

the oil. 
Pepper, black, 

Cayenne, 
Peppermint, the oil. 
water. 
Pith of sassafras. 

Quassia. 
Quince seeds. 

Resin. 

Rhubarb. 

Rose water. 

Savine leaves, powdered. 

Seidlitz powders. 

Senna. 



APPENDIX. 593 



Slippery elm bark. 

Soap liniment. 

Spiced sirup of rhubarb. 

Spirit of ammonia or hartshorn, (Aqua ammonim. 

Squills, the sirup. 

Sulphate of copper. 

of iron. 

of magnesia, {Epsom salts.) 

of potassa. 

of quinine. 

of zinc. 
Sulphur, flowers of. 
Sulphuric ether. 
Super-carbonate of soda. 
Super-tartrate of potassa, (Cremor tartar.) 
Sweet oil. 
Sweet spirits of nitre. 

Tar. 

Tartar emetic. 

Turpentine — Venice. 

Uva ursi — the leaves. 

Valerian root, powdered. 

ammoniated tincture of, 

Wax, white, 
yellow. 



LIST 



SURGICAL AND PHARMACEUTICAL ARTICLES WHICH ARE 
DESIRABLE FOR PRINCIPALS OF LARGE ESTABLISH- 
MENTS. 



1. A surgeon's pocket case, containing — 
one pair of dressing scissors. 
one pair of operating scissors. 
two scalpels, 
two curved bistouries, 
one straight bistoury. 



600' APPENDIX. 

one probe-pointed bistoury, 
one dressing forceps, 
one anatomical forceps, 
two silver probes, 
one abscess needle, 
one gum lancet, 
one spatula. 

one thumb lancet, to be exclusively used for vacci- 
nation, 
four curved surgeon's needles, 
one silver female catheter. 

2. A cupping syringe and glasses. 

3. A quart injecting syringe. 

4. A gill do. do. for children. 

5. One ( 

6. Half a dozen or more gam elastic cathen ed. 

7. One gum elai h tube. 

8. One spring lancet irith two thumb lancets in the same case. 

9. Muslin, linen, bu^ 

10. Borne skeini _ -ilk for ligatures. 

11. Three yards i •• frac- 

ture-, irith two piece* of tape, one inch bn 

12. Ten yards of anglazed domestic m 

-, from two and a half, to three fingers' breadths 
in width, and roll 
IS, A piece of cotton wadding. 

14. Half a pound of patent lint. 

15. A roll of tow. 

16. One mortar, of Wedge wood's ware, for mixtures, holding 

one pint. 

17. One mortar, of "Wedge wood's ware, for powders, hoi. 

half a pint. 

18. Two apothecary's spatulas. 

19. Several cedar shingles, planed thin. 

20. A piece of half-inch, fine panel white-pine hoard, without 

a knot, six feet long by two wide: or two pieces of 
half the width, smoothly planed. 

With these articles, kept in an accessible place, there are 
few sudden accidents which would be found unprovided for. 
No vessel should be permitted to go to sea without them, and 
on large estates, or in extensive manufactories at a distance 
from cities, they should never be wanting. Even isolated fa- 
milies would find it to their advantage to provide space 
enough for all the articles, except, perhaps, the first and se- 
cond items, which form the most expensive part of the appa- 
ratus. 



INDEX 



TO 



THE FIRST PART. 



Page. 

Abciomen, limits of the cavity 
of the, 81 

Absorption, function of, 93 

Absorbents. See Lacteals. 

Action and reaction, of the ba- 
lance of vital, 162 

Air and moisture, hygienic re- 
marks on, 197 

Alcohol, and alcoholic liquors, 
hygienic remarks on, 178 

Alcoholic liquors, necessity of 
using them in tropical cli- 
mates, 179 

Alimentary canal, anatomy of 
the, 67 

Anatomy, structure of the hu- 
man body, 25 

Ankle joint, anatomy of the, 53 

Animals, preliminary remarks 
on the organization of, 17 

Aorta. See Route of Circula- 
tion. 

.Arachnoid membrane, defini- 
tion, 119 



B 



Basin or pelvis, bony anatomy 

of the, 41 

Bladder, anatomy of the, 104 

Blood. See Circulating Fluids. 
Boarding school discipline, fe- 
male, errors of, 220 
Abuses of punishments, which 
involve exposure to cold and 
limitations of diet, 223 
Boarding schools, the food of 
children at boarding schools 
76 



Page, 
often limits their literary 
advancement, 219 

Calisthenic exercises and 

games, 221 

Choice of the house-keeper, 

matron, or nurse, 222 

111 effects of long sessions, un- 
comfortable benches, and 
the music stool, 220 

Improper exposures to cold 
and dampness, 221 

Boarding schools, ludicrous an- 
ecdotes of abuses at, 223 
Bone, of the arm, 48 
Bones, of the forearm, 49 
Bones, alterations of bone by 

age and disease, 54 

Bones, growth and structure o£ 31 
Bones, or osseous system, ana- 
tomy of the, 31 
Bone, of the tongue, 54 
Brain, anatomy of me, 118 
Brandy, hygienic remarks on 

the use and abuse of, 179 

Breast bone, anatomical re- 
marks on the, 40 
Breathing. See Respiration. 
Bronchia, Anatomy of the, '98 
Buckskin, as an article of dress, 192 
Buildings. See Residences. 



Caonchoucl See India Rubber. 

Capillaries, anatomical struc- 
ture and functions of, 91 

Cartilages, articular, anatomi- 
cal definition, 35 



602 



INDEX TO PART I. 



Page. 

Cavity of the abdomen, limits 
of the, -1 

Cellular tissue, anatomical struc- 
ture of the, 25 

•Cerebellum, or lesser brain, 119 

Cerebrum, or greater brain, 120 

Chewing- of tobacco, hygienic 
remarks on, 174 

Children and old persons re- 
quire most clothing, II I 

Children, exercise and manners 
of, erroneous popular proverbs 
concerning the, 

Children, false doctrine, that 
children are hardened by ex- 
posure with light clothing — 
cruel sacrifices to this d 
trine, . 190 

Children, food of. See Food. 

Children require more lbod 
than adu 170 

Children, that "children thrive 
best in the dirt," an erroneous 
popular proverb, 

Chyme, definition of. 

Circulating fluids, of the, 

Circulation, of the, 

( 'imitation, route of the. 

Clavicle. Bee Collar l>< 

Clerks, their in-door exercises 
unhealthy. 

Clothing, changes of, which are 
admissible at different hours 
of the day or night, 101 

Clothing, children and old per- 
sons require n 

Clothing, dangers of the jwirtial 
exposures of the person 
peculiar;!. 186 

Clothing, false doctrine that 
children are hardened in 
stitution by light (I res- 
Clothing, hygienic remark- i n. L89 

Clothing, injurious effects of too 
little, 

Clothing, injurious effects of too 
much, 1*1 

Clothing, on buckskin as an ar- 
ticle of. 192 

Clothing, on cotton as an arti- 
cle of, 190 

Clothinsr, on India rubber as an 
article of. 198 

Clothing, on linen as an article at, 199 



skins as articles o£ 



ion 



Page 

Clothing, on silk as an article 
of. 191 

Clothing, on wollen and flannel 
as articles of, 192 

Clothing, principles which should 
regulate the choice of materi- 
als for, 1S9 

Collapse, phvsiological defini- 
tion of, 139 

Collar bone, definition, 47 

Colon, or great intestine, func- 
tions and anatomy of the, 81 

Colon, valve of the, 

Cotton, viewed as an article of 
dr« 190 

Counter-irritation, physiologi- 
cal explanation of, 114 

Cranium, osseous structure of 
the. 

Cuticle, or scarf skin, anatomi- 
cal character of the, 109 

Cuticle, shed annually, IM 

Cuticle, removal of the surplus 
cuticle i: to health 

and clean' 195 

vera, or true skin, anato- 
mical characU- 106 



1). 



. 
ion, function of, 7<» 

Btive apparatus, anatomi- 
cal description oft! 

Drink, abominable habit of g - 
children stimulating. 

Drink, alcoholic, -hygienic re- 
mark 178 

Drink, distention and debility 
•omach from taking too 
large a quantity of. 

Drink, injurious effects of the 
immoderate use of water by 
children, 

Duodenum, anatomy and func- 
tions of the. 

Duplicaturc of organs, remarks 
on the. 129 

Dura mater, definition, 11** 

Dwelling-houses, see R I 

d bv eating too 

rapidly. 
Dyspepsia, caused by over cat - 
inu; 



INDEX TO PART I. 



G03 



_ . Page. 

Dyspepsia, caused by taking 
too much iluid, 176 



Eating rapidly, an American 
vice, producing dyspepsia, 109 

Engorgement, definition and 
physiological view of, 156 

Epidemics, atmospheric: causes 
of, 198 

Epidemics, caused by changes 
of temperature and moisture, 199 

Epidemics, telluric influences 
as causes of, 199 

Exciting cause, physiological 
definition of, 141 

Exercise and rest, bad effects 
of excessive, 211 

Exercise,domestic, within doory, 
always insufficient for health, 
and often injurious, 206 

Exercise, evils of sectarian pre- 
judices against certain, 208 

Exercise, hygienic remarks on, 206 

Exercise, importance of its be- 
ing agreeable and voluntary, 209 

Exercise, importance of rest af- 
ter, 208 

Exercise, rubbing furniture, a 
popular, but highly injurious 
prescription for girls who are 
crooked or round shouldered, 207 

Exercise, importance of surgi- 
cal advice in regulating, 208 

Exercise, injurious effects of 
partial, 207 

Exercise, mental, of one facul- 
ty, a counter-irritant reme- 
dy in disease or hyper-action 
of another faculty, 210 

Exercise, muscular, a counter- 
irritant remedy in mental- 
and bodily disease, 210 

Exercise, passive, invaluable in 
states of extreme debility, 212 

Exercise, to be useful, must be 
taken in the open air, 207 

Exposure, of the person, dan- 
gers of partial, 186 

Exposure, of the person, dan- 
gers of, particularly at cer- 
tain hours, 194 

Exposure, of the person, to ren- 
der children hardy, destroys 
numbers, 183, 190 

Extremities, bones of the, 47 



Pag«. 

Fainting, mechanism of, 61 

Fascia, definition of, 6fr 

Fat, structure of, 29 

Femur, the bone of the thigh, 

see Hip Joint. 
Fever, causes of, definitions of 
the proximate, exciting and 
predisposing, 141 

Fever, intermissions in, physio- 
logical explanation of, 140 
Fever, remissions in, physiolo- 
gical explanation of, 140 
Fever, symptomatic physiolo- 
gical explanation of, 138 
Fibula, one of the bones of the 

leg, 52 

Fingers and thumb, bones of 

the, 50 

Flannel, as an article of dress, 192 
Food, abuse of cakes and doughy 

articles for children, 218 

Food, both vegetable and animal 

food required by man, 166 

Food, children require more 

food than adults, 176 

Food, principles which should 
regulate the change of the 
diet of children as they ad- 
vance in age, 215 
Food, hygienic remarks on, 166 
Food, mastification of, rapid 

eating very injurious, 169 

Food, milk improper for food 

after a. certain age, 213 

Food, mode of rendering milk 

wholesome for adults, '214 

Food of children, on the pro- 
per, 213 
Food, of the quantity required 
at different ages and sexes, 
and by those of different ha- 
bits, 175- 
Food, plain biscuit or bread ne- 
cessary for children immedi- 
ately after dressing in the 
morning, 219 1 
Food required much more fre- 
quently than at meal times, 
by growing children, 219 
Food, see Drink. 
Food, stimulating, extremely 

improper for children, 218 

Food, required in old age, and 
in tropical climates after long 
residence,. 176 



001 



I.VDEX TO PART I. 



Food, the quantity required de- 
pends on the amount of i 
cise taken by the individual, 

Food, the proper time of wean- 
ing a child, 

Food, varieties of food arc ren- 
dered necessary by custom, 
climate, occupation, age and 
sex, 

a 



169 
215 

167 



-lion, nervous, definition, 11 1 
Gin, hygienic remark 178 

Girls, errors of female school 
discipline, 

etiolated, and rendered 
sickly by donp 
under tip 
that won: 
should i to home, 

iiould be 
agreeable and voluntary, 309 

. poaiefameata for, i 
- and cruelty of those 
which invul\< • io 

cold, or limitation of <!. 
Girlt, improper exposures, to 

cold and dampi 
Girls, round-shouldered, bad cf- 
iul 
rubbing furniture, 
Girls, Bad effects on their 
health and figure from 
sessions at school, uncm; 
table benches) and the ma 
ol, 
Glands, absorbent, l\u 

the, 
Glands, salivary, snetom 

position and function ofthl . 71 



II 



Hardening the constitution of 
children by exposure, a I 
unwarrantable notion, L8a\ 
Here skins, medicated as arti- 
cles oi' di 
Head, bony a tlU C Un s of the. 
Heart, anatomy and functions 

of the, P6 

Hip-joint, bony anatomy of the. 51 
Humerus os humeri, see Hone 

of the Arm. 
Hygiene, remarks on, 1(36 

Hyoidca os, the bone of the 



tongue, 
Hyper-nutrition, physiological 

view of, 
Hyper-nutrition, treatment of. 

physiological principles of, 

proper, 



Jejunum. See Y. 5 mill. 

Ileum. See In nil. 

Ilium. 

India-rubber, viewed as an ar- 
ticle of dress, 

Inflammation, errors in the de- 
finit: 

Inflammation, general ph\ 
gicnl vie 

Inflammation, healtl 
wh I be discart 

.1 de- 
finit! 

Irritation, capi! '>ogi- 

cal 

cal 

Irritation, physiological 

Irritation. he propa- 

■ of, 

the, 
fnteetii 



the. 
Knee-cap, or knee-pan, 

-joint, bony anatomy 



Lacteals, anatomy and func- 
tions of the, 

Larynx, anatomy and fum 
of the. 

Ligaments, anatomical defini- 
tion of the, 

Linen, as an art reaa, 

the, 
Lymph. cats. 



147 



l.")l 



l: 1 

117 
149 

-1 



lfW 






INDEX TO PART I. 



605 



M 



Matrimony, hygienic princi- 
ples which should govern it, 226 

Matrimony, its influence on 
the health of the mother and 
offspring, on hereditary dis- 
eases and moral peculiari- 
ties, 226 

Medical theories, defence of, 131 

Metastasis, physiological defi- 
nition of, 146 

Miasm, miasmata, definition, ef- 
fects of, 199 

Milk, becomes unwholesome 
after the proper time for 
weaning, 213 

Milk, mode of rendering it 
wholesome for adults, 214 

Moisture and air, hygienic re- 
marks on, 197 

Muscle-like coat of the arteries, 
remarks on the, 61 

Muscles mixed, description of 
the, 62 

Muscles, notice of the diseases 
of, 66 

Muscles, or muscular system, 
anatomy of the, 56 

Muscles, voluntary and invo- 
luntary, description of the, 59 

Muscular fibre, construction of 
the, 57 



. Page. 

Page. Os innominatum. See Pelvis. 
Os ischium. See Pelvis. 
Os sacrum. See Pelvis. 
Osseous system, anatomy of the, 31 



N 



Nerves, anatomy and functions 
of the, 111 

Nerves, colour and consistence 
of the, 111 

Nerves, divided into several 
systems, 22 

Nervous matter, intimate struc- 
ture of, 111 

Nutrition, function of, 92, 126 



Occipital bone, definition, 
Os coccygis. See Pelvis. 
Os femoris, the thigh bone. 

See Hip Joint. 
Os Hyoides. See Bone of the 

Tongue. 
Os humeri. See Bone of the 

Arm. 
Os ilium. See Pelvis. 



Pancreas, anatomy and func- 
tions of the, 78 
Parietal bones, definition, 46 
Passive exercise, remarks on, 212 
Patella, anatomical position and 

action of the, 52 

Pelvis, bony anatomy of the, 41 

Periosteum, definition, 34 

Peritoneum, arrangementof the, 70 
Phrenology, anatomical basis 

of, 120 

Physiology, definition, 126 

Pia mater, definition, 119 

Plexus,, nervous, definition, 112 
Portal vessels, anatomy and 

functions of the, 89 
Pre-disposing cause, physiolo- 
gical definition of, 141 
Proximate cause, physiologi- 
cal definition of, 141 
Pubis. See Pelvis. 



Radius, one of the bones of the 
fore-arm, 49 

Re-production of parts in the 
healing of wounds, 133 

Residences, defects of domestic 
architecture as displayed in • 
American, 203 

Residences, effects of vegeta- 
tion in rendering them 
healthy, 200 

Residences, effects of heights 
and ridges in rendering them 
unhealthy, 204 

Residences, general healthfull- 
ness of in a well cleared coun- 
try, 201 

Residences, healthfulness of, in 
47 wild country, 200 

Residences, heated roofs a 
source of disease, creating 
an artificial hot climate, 203 

Residences, importance of an 
elevated site for, 202 

Residences, importance of the 
choice of soil, the direction of 
the prevalent winds, the po- 



606 



JNDEX TO PART I. 



Po- 
sition of trees, a garden, and 

ornamental vines, to the 

healthf'ulness of, 203 

Residences, location and venti- 

' lationof, 200 

Residences, means of regulating 
the temperature and moist- 
ure of, 205 

Residences, selection of vines 
and creepers, for ornament- 
ing, 205 

Residences, the upper stories 
more healthy than the 
ground floors, 

Residences, unhealthy in new- 
ly cleared, and very fertile 
reg:< 201 

Residences, unhealthy in the 
neighbourhood of swamps and 

Respiration, apparatus of, 

Respiration, function of, 100 

MOD, physiological defi- 
nition of, 1 10 

Ribs, anatomical remarks on 
the, 30 



S 



Sacrum. See P> 

Saliva, its uses in mastication 
and digestion, 171 

Salivary glands, anatomical po- 
sition and function 71 

Scapula, or shoulder blade, 1- 

Schoo <ool. 

Secretion*! defioitia 102 

Share bom ill, 

Shin bone. Bee Tibia. 

Shoulder blade. IS 

Silk, viewed as a material for 

dr. UN 

Skeleton, anatomy of the, 
Skin, function of the, 110 

Skin, anatomical structure of 

the, 107 

Skin, scarf, or cuticle, of the, 100 
Skin, true, or cutis vera, of the, 1<N 
Smoking, hygienic remarks on, 17 1 
Snuff-taking, hygienic remarks 

on, 1 72 

Spinal marrow, functions of the, 117 
Spine, anatomy of the, 36 

Sternum or breast bone, ana- 
tomical remarks on, 10 
Stomach, anatomical position 
and functions of the. 7;^ 



Pa^e 

Stomach, distended and debili- 
tated by excess of drink, 176 

Stomach, distended and debili- 
tated by excess of food, 175 

Synovial membranes, their po- 
sition and uses, 35 

System, circulatory. See Cir- 
culation. 

System, nervous division of 
the, 22 

Svstem, muscular, anatomy of 
the, 56 

System, osseous, anatomy of 
the, 31 

System, portal. See Portal 

M Is. 



Telluric influence, a supposed 
cause of epidemics 199 

Temporal bones, 

Temperance, ultra, absurdity of 
the principles of, 177 

Tendons, description of the, 64 

:is, notice of the diseases 

66 

Thumb, bones of the, their im- 
portance, 50 

Tibia, one of the bones of the 
leg, 

. ■, adipose, anatomical 
structure of the, M 

Tissue, cellular, anatomical 
structure of the, 

!>.p Joint. 

Tobacco, hygienic remarks on, 17'J 

Trachea, or windpipe, anatomy 
of the, 

Transformation of tissues,. 163 



U 



one of the bones of the 
forearm, 

Union, in wounds, physiologi- 
cal history of, 135 

Ureter. See Knhuy. 

Urethra, the external urinary 
canal, 105 

Urinary apparatus, anatomy of 
the, ' 

Urine of the, 



Vicarious discharges, physio- 
logical view of. 



NDEX TO PART II. 



007 



W 



Page. 



^Weaning, the principles which 
should regulate the weaning 
ofchildren, 215 

Whisky, hygienic -remarks on, 179 
Windpipe. See Trachea, 
Bronchia, and Larynx, 



Wollen, as an article of dress, 
remarks on, 

Wounds, of the re-prod uctior^ 
of parts after, 

Wounds, union of, physiologi- 
cal history of the, 

Wounds, of symptomatic fever 
from, 

Wrist, bones of the, 



Page. 

192 
133 
135 

138 

50 



INDEX OF PART II. 



Paee. 

Abdomen, contusions in the, 275 
Abdomen, incised wounds of 

the, 250 

Abdomen, lacerated wounds of 

the, 257 

Abscesses, 359 

Abscess, of the mamma (puer- 
peral,) 537 
Absorbents, inflammation of 

the, 426 

After-birth, nature of the, 414 

After-birth, partial separation 
of the, effects on the mother 
and child, 414 

Ague, 388 

Anasarca. See Cellular Drop- 
sy. 
Aneurismal varix, 299 

Aneurism from anastomosis, 300 
Aneurisms, 298 

Angina pectoris, 443 

Ani prolapsus, 287 

Anus, dilatation of the, 287 

Aphthous sore moutli in chil- 
dren, 548 
Apoplexy, 484 
Appendix, 583 
Arm, dislocation of the arm 

into the arm pit, 331 

Arm, fractures of the, 323 

Arteries, enlargements of the, 298 
Asafcetida mixture, or tea, 583 

Ascites, 489 

Asthma, 441 



B 

.Bandage, suspensory, for vari- 
cocele, 294 
Bandages, their application in 

wounds, 244 

Basilicon ointment, 591 

Bed-stead, for the bed-ridden, 329 
Biles, 363 

Bites of serpents. See Poi- 
soned Wounds. 
Bladder, palsy of the, 537 

Bleeding, from the nose, 506 

Bleeding, mode of arresting 

hemorrhage in wounds, 236 

Blister ointment, 588 

Blood, spitting of, 439 

Body, coming down of the, 287 

Boxing the ears, ill effects of, 263 
Brain, concussions of the, 264 

Brain, compression of the, 267 

Breast bone, fractures of the, 
See Contusions of the Chest. 
Breast. See Inflammation. 
Brown mixture, 584 

Burns, remarks on burns produ- 
cing collapse 346 
Burns, treatment of burns un- 
attended by collapse, • 368 



Camphor julap, 


584 


Camphor mixture, 


584 


Cancer, 


378 


Cancer of the uterus, 


" 580 



G08 



INDEX TO PART II 



Canker of the mouth, in chil- 
dren, 806 

Carbuncle, nature and treat- 
ment of, 
epsy, 
rrh," 

Cellular dropsy, 1-- 

Cerate, of impure carbonate of 
zinc, or Turner's cerate, 

'e, simple, 666 

Chafing, from friction, 

Chafing 1 , in the folds of the 
groin, . 

Chalk mixture. 

Chalk mixture, with kino, 

Chancre. 

the, 
lacerated wounds of 

Child, mauagemfOt of the 

Child at hirth, BM 

Child, connexion! of the child 

in th<* womb, 
Chlorosis, 

( 'holm, li 1 18 

< "holrra mfaiitiim. 

Cholera, malignant. I'mi 

' <>n, 
cle, fractu 
Club 
Colic, 
Colic, in i! ' 

IBB 

Col la; >ntS 

nnd inflammtl 
Coming down of the body, 
Compression of the brain, 
Concussion of the brain, 

Constipation. 

mmption, 

ContuskMM from blows on the 
tbdomen, 

Contusions, injuries of the head 

from. 
Contusions m the cavity o\' the 

spine. 
Contusions of the abdomen, 
Contusions of the chest, 
Contusions of the greet C 



Contusion 

Conti; and 

^ sol 

Contusions of the pelvis and pe- 
rineum, 

-ions of the soft parts 
ab ne, 

of the stomach, 
us, l-l 

Convulsions, from accidental 
and transient causes, 

al, 
•1c of curing, 
. soft, 
1 ness, V*\ 

Costivcncss, in infants, 

:>ox, 11<» 

ip, 
Croup, 1 17 

nil 

y of nos- 

larjnirca. See 
Or. 

nchc, parol idea. See 

tonsillaris. Sec 



D 



Dcco 

f oak bark, 
nee peed, 

aural passages, 

the ankle, with 

frarture o\' the fibula, 

at ions of the arm into 

ationsof t 
Dislocations sudden, of the ver- 
tebra?. 

Dropsy cellular, I — 

v in the brain. 
Dropsy, in the brain, in infants. 



XDEX TO PART II. 



009 



Dropsy in the chest, 
Dropsy of the abdomen, 
Drowning, 


Page. 

489 
489 
511 


Dry gangrene, 

Dysentery, 

Dyspepsia, 


348 
457 
497 


D 




Ear-ache and suppurations 


in 



the ear, 

Ear, foreign bodies, and insects 
in the, ' 

Ears, boxing the, injurious ef- 
fects of, 

Elbow joint, fractures of the, 

Epilepsy, 

Erysipelas, 

Erysipelas in infants, 

Erysipelas phlegmonodes, 

Excoriations of the mucous ori- 
fices, 

Excoriations, see Chafing. 

Eye, film on the, 

foreign substances in the, 

Eye, inflammation of the, 

Eye-lashes, ulceration of the, 



Falling of the womb, 

Femoral hernia, definition, 

Fever, bilious, 

Fever, continued, 

Fever, description of, 

Fever, intermittent, 

Fever, miliary, 

Fever, petechial, or spotted, 

Fever, scarlet, 

Fever, yellow, 

Fibula, fractures of the, with 

dislocation of the ankle, 
Film on the eye, 
Fingers, fractures of the, 

Flatulence, 

Flooding, see Menstruation, 
excessive, and Uterine He- 
morrhage. 

Fluor albus, 

Foetus, see Child. 

Fore-arm, fractures of the, 

Foreign bodies in the ear, 

Foreign bodies in the eye, 

Formulary, 

Fractures, about the shoulder- 
joint, 

77 



356 



355 



Page. 

Fractures, bed-stead for, 329 

Fractures, general remarks on, 319 

Fractures of the arm, 323 

Fractures of the clavicle, 321 

Fractures of the elbow joint, 324 
Fractures of the fibula, with 

dislocation of the ankle, 332 
Fractures of the fingers and 

toes, 328 
Fractures of the fore-arm, 325 
Fractures of the leg, 327 
Fractures of the lower extremi- 
ties, 327 
Fractures of the lower jaw, 329 



263 


Fractures of the pelvis, 


279 


324 


Fractures of the ribs and ster- 




481 


num, see Contusions of the 




421 


Chest. 




557 


Fractures of the skull, 


268 


425 


Fractures of the shoulder-blade, 


323 




Fractures of the spine, 


271 


359 


Fractures of the thigh, 

Fresh cuts, absurdity of nos- 


326 


&54 


trums for, 


247 


&50 


Frost-bite, gangrene from cold, 


344 


351 


Furuncle, 


364 


349 


G 






Gall-stones, passage of, 


468 


577 


Gangrene, dry, 


343 


304 


Gangrene from cold, 


344 


400 


Gangrene from excessive in- 




393 


flammation, 


343 


387 


Gangrene from internal or 




388 


constitutional causes, 


343 


415 


Gangrene from mechanical in- 




403 


juries, 


345 


413 


Gangrene from pressure, 


344 


401 


Gangrene of old men, 


342 




Gangrene, or mortification, 


342 


332 


Gangrene, see Malignant Pus- 




354 


tule, and Carbuncle. 




328 


Gangrenous sore mouth of chil- 




493 


dren, 
Gilder's tremors, see Shaking 

Palsy. 
Glass-wounds, treatment o£ 


366 




246 


576 


Gonorrhoea, see Suppuration 


\ 




of Mucous Passages, and 


325 


Venereal Disease. 




355 


Gout, 


476 


350 


Gravel, 


500 


583 


Green fever, 


570 


. 


Gum-biles, 


357 


323 


Gum-rash, 


420 



610 



l.VDEX TO PART II. 



H 

Page 

Hanging, death by, 512 

Head, injuries of the, 20'.} 

Heart-burn, 492 

Heart-burn in pregnancy, 

Heart, dilatation of the, 

Hemiplegia, 

Hemopthisis, 

Hemorrhage, modes of arr 
ing in wound.-:, 

Hemorrhage, utorino, 
rrhage, pulmor. 

Hemorrhoids or ; 

Hernia, anatomical view of the 
pirts concerned in, 

Hernia, common inguinal, and 
concealed inguinal, defini- 
tion?, 

Hernia, direct and 

vcrtro-ip 

Horn iical, and 

iona, 304 

Hernia, operation for 
laled, 

Hernia, or rupture, 

le, irrrduciblo, 
and Blrai 

Hernia, n ... I on « 

Hern 
rad 

Hernia, symptoms, and conse- 
quences of strangulation in, 

Hernia, tax tion. 

Hernia, varicocele mistaken 
for, 
ugh, 

Hip-join' 

Hordeolum, 

Hydrocephalus, 

Hydrocephalus in children. 

Leria, 



J 



Jauml 




Jaundice in infants. 


MM 


Jaw, lower, fracture? of the. 




I leu?, or ii; 


461 


Incised wound?. 




Incontinence of urine, in chil- 




dren, 




Indigestion, 




Inflammation, and abscess of 




the mamma, 




Inflammation, and its c 




quences. 


835 



Pag« 
Inflammation of the absorbents, 426 
Inflammation of the c 351 

Inflammation of the eyes, in in- 

552 
Inflammation of the kidney, 466 
Inflammation of the 1 464 

Inflammation of the 1 

nipples, 
nation of the pleura, 

Inflammation of; 

i of, 1334 
, 'nation, termination in 

337 
Inflammation, termination 

342 
rmination bv 
reso! ' 335 

• rmination 

ne 

■ hen coupled 
°nt of, 

' caacariHa, •'■"■•" 

Infos >*"* 

ubo, 

seed, •">-•' 

Ml > 

-mint, 589 

-sia, 560 

na, 

mon and 

nal hernia, 

304 

Injt:r .dlapse, 

ns and sprains 
of I 
Joints, incised wounds of the. 
Join - 

41- 



K 



Kiiln. nsand rupture 

'immation of th 



Labour, management OH 

Labour, management of 
child at birth. 

Labour, preparations for the ap- 
proach of. 



INDEX TO PART II. 



Gil 



T , ^ Page. 

Labour, after-treatment of the 

mother, 525 
Lacerated wounds, 254 
Lacerated wounds of the leg, 257 
Lacerated wounds of the abdo- 
men, 057 
Lacerated wounds of the chest, 257 
Lacerated wounds of the joints, 253 
Lacerated wounds of the scalp, 247 
Leg, fractures of the, 327 
Leg, see Fibula. 

Leg, swelled or milk, 534 

Leucorrbcea, 576 

Lichen, 417 

Lientery, 456 

Lime water, 590 

Litt of drugs and apparatus, 596 
Liver, contusions and ruptures 

of the, 275 
Liver complaint, 464 
Liver, inflammation of the, 404 
Local palsy, 4S7 
Lung fever, 432 
Lying-in women, after-treat- 
ment of, 518 
Lying-in women, see Labour. 



M. 

Malignant pustule, 342 
Mammary abscess, puerperal, 537 
Measles, 412 
Menses, appearance of thr\ 572 
Menses, final cessation of the, 575 
Menses, suppression of the, 572 
Menstruation, excessive, 574 
Menstruation, obstructed, 573 
Menstruation, painful, 573 
Milk abscess, 537 
Milk of asafcotiJa, a 583 
Moles, 375 
Milk leg, 534 
Mortification, see Gangrene. 
Mother marks, from fright du- 
ring pregnancy, _ 516 
Mother spots, see Aneurism 

from Anastomosis. 

Mouth, ulcerations in the, 355 

Mumps, 444 

Mumps, in children, ' 5G5 

N 

Nails, growing into the flesh, 362 

Navel, sore, 542 

Nettle-rash, 416 



Page. 
Neutral mixture, 590 

Nipples, inflammation of the, 539 
Nitro-muriatic bath, 591 

Nose, bleeding from the, 506: 



O 



Ophthalmia, see Inflammation 

of the Eyes. 
Ointment, basiiicon-, 
Ointment, blister, 
Ointment,,cicuta, 
Ointment, celandine, 
Ointment, Kentish, 
Ointment, red precipitate, 
Ointment, savine, 
Ointment, stramonium, 
Ointment, tar, 

Ointment, white precipitate, 
Ointment, white precipitate, 

with camphor, 



Painful urination, in children, 

Palsy, 

Palsy of the bladder, puerperal, 

Palsy of the bladder, see Conti- 
nued Fever, Concussions of 
the Sjnne, and Fractures of 
the Pelvis. 

Palsy, local, 

Palsy, shaking, 

Paraplegia, 

Pelvis, contusions of the, 

Pelvis, fractures of the, 

Perineum, contusions of the, 

Phlebitis, see Veins. 

Phlegmasia dolens, 

Poultice, carrot, 

Poultice, charcoal, 

Poultice, cicuta, 

Poultice, fermenting,. 

Poultice, flaxseed, 

Poultice, yeast, 

Phthisis, 

Piles, 

Placenta, see After-birth. 

Pleurisy, 

Pneumonia, see Lung Fever. 

Poisoned wounds, 

Polypus of tiie uterus, 

Pregnancy, 

Pregnancy, abuse of blood-let- 
ting in, 

Pregnancy, unpleasant symp- 



591 
583 

591 
591 
59 L 
592 
592 
592 
592 
592 

593 



545 

487 
537 



487 
480 
487 
278 
279 
278 

534 
594 
593 
593 
593 
593 
593 
435 
294 

431 

422 
580 
513 

515 

515 



612 



INDEX TO PART II. 



Papc. 

Pressure, gangrene from, :3i4 

Prickly heat, 417 

Prolapsus ani, 987 

Prolapsus uteri, 

Proud flesh, 3 1 1 

Pruriginous rash, 420 

Pruritis vulva), 

Puerperal convulsions, 

Puerperal fever, 

Puerperal nervousness, mania, 

and melancholy, 
Puerperal palsy of the bladder. 
Puerperal swelled throat, 
Pulmonary, see Lunq, Can- 

siiiujitioii, Hr/norrfi' 
Punctured won: 

definition, 

Pustule, malignant, 



a 



Quinine, mode of prescribing 
In i 

Quinine mixture. 
Quinine pills, 
Qu i i ■ 
Quinsy in children, 

l 

R 



Rash, gum, 




nettle, 


116 


i, pruriginous, 




Been, rose, 




Reptiles, bites of, se 




Wcundt t 




Retention of urine in children, 




Retroversion of the ei 




Rheumatism, 




Ribs, tract n res of the, sec • 




fusion* of tin < 




Ring-worm, 




Run-round, 




Rupture of the kidneys, 




Rupture of the liver. 




Rupture of the spleen. 




Rupture of the uterus, 




Rupture, see lit 

S 
Saint Vitus' dance, 






Saline draught. 


500 


Scab, the healing of a wound 




beneath a, 


246 


Scalds, treatment of, 




Scalp, wounds of the, 


•J 17 



Page. 
Scapula, see Shoulder- Blade. 
Scrofula, 376 

Skull, fractures of the, 906 

Scurvy, 384 

Shaking palsy, 

Shingles, H7 

Shoulder-blade, fractures of 

the. 
Shoulder-joint, fractures about 

the. 
Sick-room, proper management 



of the, 

Small -pox, 

Soft e 

Solution of pith of sae; 

Solution of ncetate of ammo- 
nia. [See Errata.) 

. 
Sore n 

the, 
, contusions in the cavity 
• ; ie, 

, contusions of the soft 
parts 

', curvature of the, 
, fractures and sudden 
the. 
Spirits of Mindererus. [See Er- 

-amphor, 
Spitting of blood, 

i), contusions and ruptures 

:ie, 

ir use in wounds, 
Sprains of the joints, 

urn, fractures of the, see 

i 
■eh, blows on the, 
in the bladder, see Gra- 

■ing. habit 
Strangulated nan 
Strang 

Summer complaint, sec Ckole- 

I /ant urn. 
Suppuration of the 
Suppuration of the ur: 

3o9 
Suppc .46- 

Suppuration, termination of in- 
flammation in, 337 

Suspended animation, see 
Drowning, $r* 



MM 



B86 
606 

281 






INDEX TO PART II. 



613 



o Page. 

Suspended animation of the 

child at birth, 524 

Suspension, death from, 512 
Suture, or stitching in wounds, 242 

Swelled breasts of infants, 542 

Swelled leg, 534 

Swelled throat, puerperal, 537 



Terebinthinic mixture, 595 

Thigh, fractures of the, 326 

Throat, incised wounds of the, 248 
Thrush, aphthous sore mouth of 

548 
328 
541 



children, 
Toes, fractures of the, 
Tongue-tie, 

Tourniquet, see Bleeding. 
Turpentine mixture, 595 



U 



Ulceration of the cornea, 354 
Ulceration of the eyelashes, 349 
Ulceration of the mouth, 355 
Ulceration of the mucous orifi- 
ces, 359 
Ulceration, treatment of, 338 
Ulcer, healthy, a misnomer, 338 
Ulcer, indolent, 340 
Ulcer, irritable, 339 
Ulcer, spreading or phagede- 
nic, 338 
Ulcer, varicose, 292 
Union by the first intention, 239 
Union by the second intention, 240 
Urinary consumption, see Dia- 
betes. 
Urination, excessive, see Dia- 
betes. 
Urination, painful, in children, 545 
Urine, retention and suppression 

of, in children, 545 
Urine, incontinence of, in chil- 
dren, 547 
Urticaria, see Nettle Rash. 
Uterine hemorrhage, 526 
Uterus, anteversion of the, 579 
Uterus, cancer of the, 580 
Uterus, inflammation of the, 531 
Uterus, inversion of the, 530 
Uterus, polypus of the, 580 
Uterus, prolapsus of the, 577 
Uterus, retroversion of the, 579 
Uterus, rupture of the, 525 



V. 

Vaccination, method of, 411 

Vaccine disease, 410 

Varicose aneurism, 299 

Varicocele, 293 

Varicose ulcers, v 292 

Varicose veins, 290 

Varioloid, 409 

Venereal disease, 380 

Veins, inflammation of the, 426 

Ventral hernia, 304 

Ventro-inguinal hernia, 304 

Volatile liniment, 596 

Vomiting, 502 

Vomiting in infants, 555 

W 

Warts, 375 

Water-brash, 493 

Water in the brain,. 490 

Water in the brain, in chil- 
dren, 562 
White looseness, 456 
Whites, 576 
White swelling, 370 
Whitlow, 361 
Whooping-cough, 563 
Worms, 470 
Worms, in infants, 561 
Womb, see Uterus. 
Wounds and contusions, 235 
Wounds, fresh, absurdity of nos- 
trums for, 247 
Wounds, healing of, by scab, 246 
Wounds, incised, 236 
Wounds, incised, — mode in 
which nature effects the 
cure of, 236 
Wounds, incised, — of the abdo- 
men, 250 
Wounds, incised, — of the chest, 249 
Wounds, incised, — of the joints, 252 
Wounds, incised, — of the neck 

and throat, 248 

Wounds, incised, — of the scalp, 247 
Wounds, incised, — treatment 

of, 242 

Wounds, lacerated, 254 

Wounds, lacerated, — of the ab- 



domen, 
Wounds, 

chest, 
Wounds, 

joints, 



257 



lacerated, — of the 
lacerated, — of the 



249 

258 



614 



INDEX TO PART II. 



Page. 

Wounds, lacerated, — of the 

leg-, a mode of treating, 257 

Wounds made by glass, 246 
Wounds, modes of stopping 

bleeding in, 236 

Wounds, poisoned, 422 

Wounds, punctured, 288 



Pat« 

Wounds, union by the first in- 
tention in, 239 

Wounds, union by the second 
intention in, 240 



Yellow skin in infants, 



M 



ERRATA. 

Page 304, line 3, for "internal," read — external. 
Page 327, line 21, for " three keg hoops," read— two keg hoops. 
Page 595, line 9, for "muriate of ammonia," (Sal Jmmonia,) read—car- 
bonate of ammonia. 



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PHYSIC \1. CONDITION OF MAIS, 

{Hrincipally with reference to the supply of 
lis wants, and the *\<r. ise of his intellec- 
tual faculties. By John Kinn, M. D., F. 
of .Medicine in the 
University of Oxford; being a part of the 
Bridgewater Treatises on the Power, Wis- 
dom, and Ooodness of Cod, ns manifested 
in the Creation. In 1 vol. 12mo. 



PROFESSOR KIRBY. 
'HE HISTORY, HABITS, AND IN- 



STINCTS OF ANIMALS. By the Rev. 
William Kirby, M. A., F. R. S. In 1 vol. 
8vo. Illustrated by numerous engravings 
on copper; being a part of the Bridgewater 
Treatises on the Power, Wisdom, and 
Goodness of God, as manifested in the 
Creation. 



BARONLARREY. 

SURGICAL MEMOIRS OF THE CAM- 
PA ICNSOFRUSSI A, GERMANY'. AJND 
FRANCE. Translated from the French 
of Baron Larrey. In 8vo. with plates. 



ISAAC LEA. 

I 1 1 \ TRIBITIONS TO GEOLOGY r . Illus- 
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By Isaac Lea, Member of the American 
Philosophical Society, &c. &c. In 1 vol. 8vo. 



By the same Author. 

\ SYNOPSIS OF THE FAMILY OF 
\ \l IDES. By Isaac Lea, Member of 
\merican Philosophical Society, &e. 
.\< . 1 \ol. 8vo. with coloured plates. 



PROFESSOR MECKEL. 

MANUAL OF GENERAL, DESCRIP- 
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ATOMY. By J. F. Meckel, Professor of 
Anatomy at Halle. &c. &c. Translated 
from the French, with Notes, by A. Sidney 
Doane, A. M., M. D. 3 vols. 8vo. 



MARTINET. 

MANUAL OF PATHOLOGY: containing 
the symptoms, Diagnosis, and Morhid Cha- 
racter of Diseases, &c. By L. Martinet. 
Translated, with Notes and Additions, by 
Jones Quain. Second American Edition. 
12mo. 



PHRENOLOGY. 

PHRENOLOGY, and the Moral Influence 
of Phrenology. Arranged for general 
study, and the purposes of education, from 
the first published works of Gall and Spurz- 
heim, to the latest discoveries of the pre- 
sent period. By Mrs. L. Miles. 

"Man's greatest knowledge is himself to 
know." Pope- 



Books published by Carey, Lea fy Blanchard. 



PROFESSOR PROUT. 

CHEMISTRY. MPNKRAI/XiY.ANDTHE 
FUNCTIONS OF DIGESTION, consider- 
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By Wm. Pium r. M. U.. V. R. S.. I allow of 
the Royal College of I' Being 

a part of the Bridgewster Treatises, on) 
the Power, Wisdom, ami Coodneae of! 
God, as niauifi ~t< d in tin- Creation. 1 vol. 
12mo. 



don Fever Hospital, 
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PROFESSOR SYME. 

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inborg. Jn 1 \ui. s vu. 



USHER PARSONS, M. D. 

DIRECTIONS FOR MAKING \\ \tomi- 
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basil of Pole, Marjolio, and i: 
including the wn method <>i Mr 

By I 

Anatomy and Surgery, l rol. 8va, with 
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DR. TWEEDIE. 
CLINICAL ILL! STRATIONOF 



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ANIMAL AM' VEGETABLE PIIYSI- 
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LADT8 MEDICAL Gl tDl Bj Rwauu 
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\ RATION \I I IXPOSTTIOJi OF THE 

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Books published by Carey, Lea cy* Blanchard. 

THE MEDICAL STUDENT. 

THE MEDICAL STUDENT, OR AID TO THE STUDY OF MEDICINE, including 
a Glossary of the terms of the Science, and of the mode of prescribing; Bibliographical 
Notices of Medical Works; the regulations of the different Medical Colleges of the 
Union, &c By Robley Dunglison, M. D., Professor of the Institutes of Medicine and 
Medical Jurisprudence in Jefferson Medical College, late Professor in the University o 
Maryland, and University of Virginia, &c. In 1 vol. 8vo. 

"This is another of those valuable compilations for which the profession in America is so 
much indebted to Professor Dunglison. 

"Although chiefly intended for students in the American States, it will be useful for stu- 
dents in all countries, as it contains a vast deal of that kind of miscellaneous and varied 
information which is so constantly needed, yet so difficultly found by them. Besides the 
mere technical matters, this volume touches on many subjects of yet higher importance, 
and, among others, on the moral duties and professional conduct of the medical practitioner! 
which are laid down clearly and forcibly, and with a just appreciation of the dignity of the' 
office. The following titles of the live chapters of which the work consists, C will give a 
general but not very exact notion of its contents, as it comprehends many things very in- 
teresting to the student, yet hardly suggested by its title: Preliminary education, Medical 
education prior to attendance on Lectures, Medical education during the period of atten- 
dance on Lectures, Medical education after Graduation, a Medical Bibliography for the 
Student and Young Practitioner. 

"We recommend 'The Medical Student' in the strongest terms to his brethren in all 
countries, and in an especial manner to his compatriots." — British and Foreign Medical 
Review. 



GENERAL THERAPEUTICS. 

GENERAL THERAPEUTICS, OR PRINCIPLES OF MEDICAL PRACTICE, with 
tables of the chief remedial agents and their preparations, and of the different poisons and 
their antidotes. By Robley Dunglison, M. D., &c. &c. 1 vol. large 8vo. 

"There being at present before the public several American works on Therapeutics, 
written by physicians and teachers of distinction, it might be deemed unjust in us, and 
would certainly be invidious, to pronounce any one of them superior to the others. We 
shall not, therefore, do so. If there be, however, in the English language, any work of the 
kind more valuable than that we have been examining, its title is unknown to us. 

"We hope to be able to give such an account of the work as will strengthen the desire 
and determination of our readers to seek for a farther acquaintance with it, by a candid 
perusal of the volume itself. And, in so doing, we offer them an assurance that they will 
be amply rewarded for their time and labour." — Transylvania Journal, Vol. IX. No. 3. 
Dec. 1836. 

"Few writers in our profession have been more industrious than Professor Dunglison, and 
fewer still have sustained themselves equally well in the course of so many practical pub- 
lications. From the hasty perusal which we have given it, we are inclined to think that 
it possesses equal if not superior merit to any which have preceded it from the prolific pen 
of its author. 

It shown the learning and research of its author on every page, and as an eclectic 
production it will bear comparison with similar works in any country. We would advise 
our readers to purchase and peruse it for themselves." — Western Journal of the Medical 
Sciences, No. XXXVIII. p. 252, for September, 1836. 

The work ought not to be thus hastily dismissed. From an attentive examination less 
cannot injustice be said, than that while we find nothing to excite a single captious feeling, 
we find every thing to instruct and entertain. Although Dr. Dunglison may be regarded a 
prolific writer, if he produces alwavs such volumes as this, we shall certainly notthinkhim 
in danger of the charge of overworking his genius. We must leave it with the candid 
advice to every medical man to be soon in possession of this volume of sound and rich ob- 
servations in the art, he would advance with pleasure, as well as practice as a duty. — 
Boston Medical and Surgical Journal. 



Books published by Carey, Lea fy Bluiichurd. 

YOUNG'S MATHEMATICAL WORKS. 

AN ELEMENTARY TREATISE ON ALGEBRA, Theoretical and Practical: with 

attempts to simplify some of the more difficult parts of the science, particularly the de- 

inonstration of the Binomial Theorem, in its most general form: the Solution of Equations 

of the higher orders; the Summation of Infinite Series, dbe. By J. R. Young. A new 

edition, corrected and improved. 

"A new and ingenious general method of solving Equations has been recently discovered 
by Mem* II. Atkinson, Holdred, and Horner, independently of each other. For the best 
practical view of this new method and its applications, consult the Elementary Treatise on 
Algebra, by Mr. J. R. Young, a work which deserves our cordial recommendation." — Dr. 
Gregory' $ edition qfHutton't Matin maticg. 

"For the summation of Infinite Series the author g and ingenious method, 

which is very easy and extensive in its application" — NewautU M 
ELEMENTS OF THE INTEGRAL CALC1 LUSi frith its Applications to Geometry 

and to the Summation of Infinite S' r I and corrected by Michael 

O'Siiawlssv . A. M. 1 vol. 8vo. 

'•The volume before ns forms the tliird of an analytical course, which commences with 
the 'Elements of Analytical Geometry.' M 
language, and we trust they will speed Uy be adopted m 

The existence of such auxibarii i will, of itself, we hope, prove an inducement to the culti- 
vation of" Amlyt: lor. to the H . ntarv works, the indifl. : 
hitherto manifested m tin.- country on the suhj. . fly to be ascribed. 
Mr. YoUDg has brought the science within the r- at, and. in so 
doing, has contributed to the advancement of mathematical learning in Great Brita. 
Preebwterian Review, January, I 
ELEMENTS OF Till: DIFFERENTIAL CALCULUS; comprehending the General 

Theory ofCurve Surfaces, and ol Cnrvei of Double Curvature. Revised and corrected 

by Michakl O'SHAjntner, \ M l vol 

•The whole Elements of the Differential Calcuh>. comprehending all that is mot valu- 
able in the large works of the most celebrated Analvsis, are contained in one volume, 
beautifully printed on a line paper, and neatly bound m cloth. It appeal! to be in « 
reaped will fitted rally adopted."— 

I'nshi/irrinn Review, September, 

ELEMENTS OF GEOMETRY; < nl lining a new and universal Treatise on the Doc- 
trine of Proportions, together with Notes, in which are pointed ool 
important error> that have hitherto remained unnoticed in the writings of I 
\1m>, an Examination of the ■\ srioua T!.. .at have bet n proposed 

by Lege n d re, Beitrand, Ivory, I^eslie, and others. 1 vol ftvo. 

"His observations on the theory of parallel lines, the labour he b "n the doc- 

trines of proportion, as well a» his corrections ol niair. -and 

supplying their defects, together with his minute atteni 
justly considered as rendering bis performance value) 
losopkical MagosuM 

"We have never seen a work so free from pretension and of such great merit. Vaj 
fallacics latent in the reasoning of some celebrated tnathei, tfa of ancient 

modern dale, are pointed out and discussed in a tone of calm moderation, which we regret 
to sty is not always employed in the scientific world." — Month 

"This is a work of valuable information. -itened mind, and 

executed with a simplicity which cannot I important truth it speaks of. home 

to the conviction ofeverv Dndei standing." — IV< 

THE ELEMENTS OF W vl.YTlcu. GEOMETRY; oomprehendtng the latrine of 
the Conic Sections, and the General Theory of Corves and Surfaces ot the second order, 
with a variety of local Problems on Lines and S - Intended for the use of Mathe- 

matical Students in S ch ools and 1 

"If works like the present be introduced generally into our schools and colleges, the con- 
tinent will not long beset of its immense superiority over the count - 
branch of modern analytical science." — Atlas, 

THE ELEMENTS OF MECHANIC^ comprehend - tad Dvnamics. with a 

copious Collection of Mechanical Problems, intended tor the use of Mathematical Stu- 
dents, in Schools and Universities] with numerous Plates. Revised and corrected by 
John D. Williams. I vol - 

ELEMENTSOF PLANE AND SPHERICAL TRIGONOMETRY; with its nppli. ations 
to the Principles of Navigation and .Nautical Astronomy, with the necessary Locanthmic 
anil Trigonometrical Tables. By J. R. \ which is added, some Original Re- 

searches in Spherical Ceometry. By T. S. I Revised and corrected by 

John D. Williams. 1 vol v 



906 






